the prof speaks out

Our new online recovery community

2008-11-19T19:32:00.002Z

I've been very quiet recently on this blog because I have been working hard on the new web community we launched today.

This blog will now close although we will keep all postings here. We have also moved all postings to my blog on the new site, but it has not been possible to move all the comments.

There will eventually be many blogs on our new online community. Please feel free to register, get your own profile page, and blog if you wish.

Please note that you will need to register to make comments on the new site's blogs. We ask that you read the Terms and Conditions of our online community. We will be trying to prevent and eradicate any offensive, abusive or troublesome behaviour on our community site.

Please take some time to look around the new site - it contains lots of interesting content. And help us empower people to tackle substance use problems.

Thanks for reading these google blogs - come over and enter our new world.

Untangling treatment

2008-11-09T16:43:00.004Z

For those of you who missed my last two Background Briefings in Drink and Drugs News, I have included the links below. After writing over 70 Briefings, I thought it was time that I reflected on what treatment involves (or should involve) and how it can help people along their path to recovery from addiction.

In the first of this series, I described a large scale piece of qualitative research that Lucie James and I conducted on the views and experiences of clients on a high quality prison treatment programme.

As psychologists, we were particularly interested in the key elements that were derived from the analysis: 'belonging', 'socialisation', 'learning' and 'support'. These themes impacted on a fifth theme, personal change, which comprised two components, motivation to change and self-esteem.

In the second Briefing, I started to look more generally at the nature of treatment and how it helps recovery. I emphasised one of the most simple and important facts - recovery comes from within the person.

I described some of the views of Arthur Bohart and Karen Tallman, as expressed in their seminal book, 'How Clients Make Therapy Work: The Process of Active Self-Healing'.

I took a brief look at what the client brings through the door when he or she comes for help from a treatment agency.

I hope you find these latest Briefings interesting. Let me know what you think.

The Wired In online recovery community

2008-11-07T05:54:00.004Z

My apologies for not blogging recently but I have been deep into writing content and testing the new online community which is close to being launched. Kevin and my blogs have been moved over onto the new site so there will be a nice archive there.

A small community has developed amongst the people testing the site and we've had some amusing experiences. Here is one of my recent postings which generated a number of comments:

'Chris G and his 200,000 followers

We have been very busy developing the website and doing related things, so it is good to have a dose of humour now and again.

Chris G emailed Lucie just now to say that some words in blue had appeared on his profile page underneath his Friends list. He now had 200,000 followers! As he said to Lucie, ‘Come with me child and I will show you the world.’

Now, we know that strange things happen from time to time, because Nathan is working on the functionality and tests things periodically.

The only problem is that Chris G is really excited about having such an impact on the world – and what is this going to do to his self-esteem when he loses his followers in one foul sweep of Nathan’s programming!

Please can you all check out that he gets back on his feet after such a loss!!

And don’t stop blogging Chris, for they may return.'

Shall we name and shame trashie newspaper reporters?

2008-10-26T17:42:00.011Z

The prejudice and stigmatisation exhibited by members of the press sickens me at times. Look at this quote from the so-called intellectual newspaper, the Sunday Times.

'A pilot scheme is encouraging druggies to kick the habit by giving them money to donate to charity'

I suggest we have a name and shame campaign to tackle this sort of trash - I am of course referring to the term 'druggies'. In this case, the trashie reporter is called John Mooney.

I did send in a comment this morning criticising the newspaper, but have yet to see it up and it is evening now.

By the way, the article is worth looking at - an interesting pilot scheme taking place in drug services in Dublin.

Maybe, we could unite on this one, rather than some people taking 'pops' at others. My blogs are there to try and induce informed debate, not to be a forum for insults. I know it's tough at times, but let's try to maintain some decorum.

And one last gripe - why do so many people in this field insist on operating on a black vs white agenda, with no middle ground?

If someone says that there is too much of (A), we need some (B)... that does not mean they want to get rid of (A). For example, you can criticise the current system of dishing out methadone without providing additional support for people - and say we are not focused enough on helping people find recovery...

WITHOUT being against methadone!!

Anyone for a good hanging?

2008-10-24T07:24:00.003+01:00

Saw this posted as a comment on one of the blogs:

'I should just let you and the prof keep posting and watch you hang yourselves.'

Guess, you cannot keep everyone happy! If there was no criticism, I'd be doing something wrong.

By the way, an excellent blog this week by Kathy Gyngell focusing on, 'Why the National Treatment Agency is prejudiced against rehab.'

Trying to support family support groups

2008-10-20T21:30:00.003+01:00

As some of you know, I am very passionate about trying to support family members, families and family support groups. They just don't get a good deal from the system - in fact, they generally get a lousy deal.

There are so many family members who need help. There are so many family support groups who are trying to do something positive - but exist in isolation and need help to further their agenda.

I would like to contact as many family support groups as possible, to try to help bring them together into a coherent whole. Or at least communicate with each other.

It is time we worked together to push an agenda that helps those who are indirectly affected by substance use problems.

If you are a family support group, or know of any such group, could you please contact me.

Thank you

2008-10-20T20:25:00.003+01:00

I'd just like to thank all those who have been involved in the last two 'debates' centered on my blog. I've not been involved in the last one as I've been tied up - other than putting up all comments onto blogs - but I will look and will join in as soon as I can.

We're getting closer to the launch of the new website, at which time I will move my google blog to this new location. We're hoping that we can get a number of different people blogging who can stimulate good discussion. We hope that this discussion will lead to other 'virtual' activities.

Meanwhile, please continue putting forward your views.

Methadone maintenance in treatment services today: a form of palliative care?

2008-10-19T15:24:00.004+01:00

Well, my Blog on Thursday, 'The power of misinformation', certainly fired up some discussion. At the moment, we have reached 37 comments. So let's see if I can do the same with this posting.

I'm writing an article at the moment on the problems with the current treatment system and what we need to do to improve matters. I'm on the methadone section at the moment.

As I have said many times before, I have nothing against methadone substitution therapy per se, but I feel strongly about it being used with clients being offered no, or only minimal other, support. I have written:

'Due to the approach adopted by much of the UK treatment system, this generally leads people from one addiction to another without providing a realistic opportunity to attain recovery.

Whilst methadone (and Subutex) have an important role to play in helping people take the chaos out of a heroin-using lifestyle, they should not be prescribed in isolation or with minimal other support.

The majority of heroin users actually want to get off drugs completely, not be “left” long-term on methadone or other substitute drugs. They must be provided with the choice of, and help in, finding a path to recovery, rather than just being helped to live with addiction. Much of the treatment system shows a shocking paucity of ambition for its clients. If cancer patients were only offered what amounts to a form of palliative care, it would be seen as a scandal.'

What do you think?

The power of misinformation

2008-10-16T15:11:00.006+01:00

Heard a depressing story this week from a friend who holds a senior position in a treatment agency. They told me of a local commissioner who was telling drugs workers that research showed that residential rehab did not work. Therefore, local commissioners were not going to send people to residential. Also, very worrying was the fact that the drugs workers believed what he was telling them!

No wonder residential centres are struggling to fill their beds with this disgraceful misinformation and attitude. How do such commissioners get to hold such a position? And exert such an influence. It is also very worrying that the drugs workers believed the commissioner.

The level of knowledge and understanding of many people working in the field does really worry me. If doctors and nurses working in our hospitals had the same level of training as many of our specialist workers, generalist workers - and commissioners in particular - we'd be running scared if we got seriously ill.

I don't like having to say this - there are many good and knowledgeable people working in our field - but one cannot escape reality. It is worrying.

As for the commissioner in question - he needs to be told the truth about good residential rehabs. And tell others the true reality!

How Clients Make Therapy Work

2008-10-13T20:33:00.003+01:00

For those of you who did not read your Drink and Drugs News, to let you know that my latest Background Briefing focused on a very interesting book, 'How Clients Make Therapy Work: The Process of Active Self-Healing' by Arthur C. Bohart and Karen Tallman.

You are going to hear a lot more about this book in my Briefings over the coming months - and on this blog. For now, I leave you with the text of my Briefing, if you have not clicked through to the DDN pdf document with my ugly mugshot!

In my last Background Briefing, I focused on two William White books that are classics in the field. In this Briefing, I describe another classic. Whilst this book focuses on mental health and psychotherapy, the ideas it contains are of direct relevance to recovery from addiction and the treatment process.

‘How Clients Make Therapy Work: The Process of Active Self-Healing’ by Arthur C. Bohart and Karen Tallman

The authors of this book argue that the most important factor in making psychotherapy work is the active, creative involvement of the client. Clients are viewed as possessing self-healing capacities and resources that are responsible for the resolution of problems and for change in everyday life – and in any form of psychotherapy.

Clients, like all people, have a built-in capacity for learning and creative problem solving, which can help them overcome problems in their lives. The capacity for creative problem solving can be enhanced or supported – or limited or distorted – by the person’s internal resources, and interpersonal and physical environments.

Their capacity for creative problem solving can also be limited by low self-esteem, feelings of discouragement, and a lack of hope.

Most people cope, survive and grow with challenges in their everyday lives without the help of a therapist.

Clients come for help with their ‘problems’ when their self-healing capacities or resources are inaccessible or blocked. Therapy is most effective when it makes use of these self-healing capacities and resources.

The most important thing that the therapist can do to be helpful is to find ways of supporting, stimulating, and energising client investment and involvement in the therapeutic process. The second most important thing is to stimulate client learning and creative problem solving.

The authors of this book view the therapist as a coach, collaborator and teacher who frees up the client’s innate tendency to heal.

The therapist may use one of the major theoretical frameworks (e.g. cognitive-behavioural or psychodynamic), but the way their help is used will ultimately be determined by the client.

Clients know the intimate details of their problems and the intimate ecological connections that are created by their problems, and they have a sense of the factors that create the problems.

They also have a much more intimate sense of what is possible in their life space than does the therapist.

Clients actively translate the lessons and experiences of therapy into their life contexts. Therapists cannot expect a one-to-one translation of their technique and ‘teachings’ into client behaviour. Clients use their own idiosyncratic uses and understandings of whatever they have learned in therapy to help them deal with their problems.

This model of the client as a self-healer is in contrast to the medical model, which still dominates psychotherapy. In the medical-like ‘treatment’ model, the therapist is analogous to a physician.

He or she is an expert on the nature of the client’s problems and on how to help alleviate these problems. He or she forms a diagnosis and then prescribes treatment, which consists of applying interventions appropriate to that diagnosis. These interventions cause change to the client, thereby alleviating the symptoms.

In their book, Bohart and Tallman provide a wealth of research evidence supporting the idea that the active efforts of clients are responsible for making psychotherapy work. They contrast their views with the medical model.

They emphasise the fact that differences in effectiveness between different therapeutic approaches have only infrequently been found. The self-healing tendency of the client usually overrides differences in technique or theoretical approach.

The authors describe the assumptions about clients, problems and change that underlie the self-healing model, and why clients come to therapy. They view therapy as a form of education and describe different ways therapy promotes self-healing.

They particularly examine how the provision of a basic empathic relationship can be helpful. Therapy is also viewed as a meeting of minds.

This book is essential reading for anyone working in the substance use treatment field. If you have any doubts about the relevance of this book, I remind you of a quote from the excellent book by Tom Waller and Daphne Rumball, “Treating Drinkers & Drug Users in the Community” (2004):

‘Other people, however skilled they may be, never make a drinker of drug user better. It is always the client who does the work. Helping professionals can make assessments, point the way, offer suggestions, provide interventions tailored to meet a client’s needs, give appropriate counselling, and do what they can to improve the client’s environment, but success, when it comes, always belongs to the client, never to the professional worker.’

So think about this the next time you meet one of your clients. And think about the following excellent quote from Bohart and Tallman’s seminal book:

‘The client is a creative, active being, capable of generating his or her own solutions to personal problems if given the proper learning climate… therapy is the process of trying to create a better problem-solving climate rather than one of trying to fix the person.’

Holidays, blogs and film

2008-10-12T16:14:00.005+01:00

Both Lucie and Kevin have taken time off for holidays, and Jim has flown over to Norway for one of his son's weddings. So that has left me holding the Wired In fort.

I've been too busy to notice their disappearance, as I've been deep in content management for the online recovery community. I left a lot of my admin to this coming week, as I really needed to make a push on the content and checking the functionality of the site.

I recently checked through and edited over 100 of my postings and over 70 of Kevin's from our Google blogs. Quite a time consuming process, I can tell you.

Actually, I found it absolutely fascinating reading all of Kevin's blogs again, this time one after another. It made real interesting reading, the thoughts of someone who has 'been there' and is passionately concerned about helping other people find recovery from addiction.

I also looked over some of his film material. I had loaned Kevin a Mac and encouraged him to take it around and film (with the internal vidcam) discussions with some of our volunteers, edit the material, and put it up on YouTube and Vimeo.

Just a standard sort of thing to do in everyday life! And Kevin has not had an everyday life!!

He has been fantastic and learnt what he needed to do really quickly. One thing that struck me when working on his blogs, was the film he put together with Brian White, one of our volunteers in Cardiff.

I ask you to take a look, to see Brian's reflections on his journey into recovery.

Given the quality of what Kevin and Lucie have been doing, it is ironic that I run out of money for them at the end of next month. So I'm trying to raise funding to keep this train on the tracks - and also feed myself.

Reflecting on heroin addiction

2008-10-09T06:42:00.003+01:00

Research shows that 78% of smokers attempt to stop smoking each year, many making several attempts. Nearly 50% do not expect to be smoking in a year’s time.

However, only 2-3% stop permanently each year.

Smoking does not generally result in the smoker losing their job and their home, the support of their family, the lowering of self-esteem, and thoughts of suicide.

Addiction to heroin can lead to these things. And yet people do overcome heroin addiction, despite the adversities they face. The recovered/recovering heroin addict may not be able to stop smoking.

Sadly, we do not know what percentage of people overcome a heroin addiction in the UK.

A productive day on the computer

2008-10-07T16:56:00.005+01:00

I'm pooped! Bloody pooped!!

Lucie, Kevin and I have been sitting in my sitting room all day, loading up material on the new website, testing the functionality of the content management system, talking to the website-developer and some community members, and trying to work on a funding application. Talk about multi-tasking.

It's fun writing and loading up new material (written and video), but the process can also get boring at times, particularly when one is looking through and checking and formatting old material. There is a lot of material we are moving over from the google blogs to our new site, not just Kevin's and my own, but also some of our community members. It's so easy to make mistakes and also miss typos, so it can become very frustrating.

And poor Lucie, the only one using a PC (and Vista), has been tearing her hair out because the website has been creating multiple windows on her screen. A programming bug that needs finding, but until it's caught poor Lucie will continue to be frustrated. Developing and launching a new website can take some time - one task that has to be done is to check the full functionality in all sorts of different web browsers.

Ultimately, the real test of the system is when lots of people are accessing the website, which should happen early next month when we launch.

For now, I feel burnt out so this rambling will have to replace my originally planned more focused blog. But I feel very happy that I have had a very productive day.

The first service user conference in Scotland

2008-10-06T17:02:00.004+01:00

I recently spent nine days in Scotland on holiday. After three lovely days on the beautiful island of Skye, we went to Saltcoats to visit Annemarie Ward, who has been working closely with Wired In. It was only the second time that I have met Annemarie in person, but I felt I had known her for ages.

Annemarie had recently spoken on recovery at the first service user conference in Scotland. Amazingly, around 700 people attended, the majority being service users. What a fantastic response to the efforts of the organisers.

Annemarie was very excited by the reaction of the audience to her talk, which I use her words to describe, ‘Well, I can tell you I was totally overwhelmed by the positive response I had from the floor during the presentation. Folks were whooping and hollering, clapping and stomping, in a really scary exciting way. After my “speech” and during the workshops later in the day, I was again really shocked by the amount of people who wanted to support me.’

I also spoke to Neil McKeganey who said he was taken aback by the nature of the positive response to Annemarie. He thought that she is a natural leader.

It’s really great to hear this, because Annemarie is helping Wired In push the recovery agenda in Scotland – she is our Scottish leader. I was really impressed the first time I met Annemarie whilst we were both visiting the LEAP project in Edinburgh. She was an absolute natural with the clients, who quite obviously took to her in a very positive fashion. She is also knowledgeable and intelligent.

We consider ourselves very lucky to have Annemarie working with us. Whilst we were out for dinner, we took the opportunity to do some plotting for pushing the recovery agenda. I was also pleased that Annemarie and my partner Linda (who is Australian) got on so well, although the latter did initially struggle with Annemarie’s accent!

I was also very touched by a special gift that Annemarie gave me – a memento signifying the 11th year of her recovery (she is now 12 years in recovery). Symbolically, it was one of the nicest presents I have ever received.

If you want to help push the recovery agenda north of the border, then let us know - tim1leg@yahoo.com or david@wiredin.org.uk.

Carers' conference in Gloucester: 'Who Cares?'

2008-10-05T16:17:00.010+01:00

It seems a very long time since I was last on the blog, having just had three weeks vacation. Lots to talk about over the coming weeks, I'm sure.

During my vacation, I gave a talk at a carers' conference, 'Who Cares?' in Gloucester. The day's event was organised by Andrea Wilson, with the assistance of Irene and Ian MacDonald, and the financial support of the Gloucester DAT.

I was really pleased to participate in such a meeting, not just because the focus was on families and carers, but because I wanted to meet Ian and Irene MacDonald. Ian first contacted me over five years ago to tell me about their work, but whilst we had met periodically we had never managed to spend some good time together. And I wanted to meet his wife.

Now this was no ordinary presentation, since I was given a 90 minute slot to talk about recovery. Now, I do not usually practice talks - and therefore do not time them - so with such a long talk, it was difficult working out how many slides to use. So I set up 72 and thought I'd leave some out as I go along, which is what happened. I attach all 72 slides here! [Please note, the file takes time to load. Let me know if you have problems]

I spent a very interesting morning listening to the other speakers. All the talks were of a high quality and there were some moving moments. I was very touched by a talk given by Laura, who reflected on the harm that her alcohol misuse had caused to her mother.

I was thrilled by the response to my 70 minute talk. Yes, 70 minutes (broken up by an 8-minute film) and the audience managed to stay awake! Talk about staying power!!

I felt genuine interest (and excitement!) in the room during and after the talk. The feedback since the event has been great. I've received many positive responses, my favourite being that I (or my message) should be bottled and passed around services (treatment agencies and generic) in the area.

Now, I know this can be viewed as blowing my own trumpet, but it is very important for people to realise that audiences get excited about the recovery agenda. I spoke about things that mattered to people in the room, things that they could understand and desire. If someone wants to 'bottle me' to get the recovery message out there and improve matters for those people affected directly or indirectly by substance use problems, then so be it! Bottled DC. Mmm!

The one disappointing aspect from the conference was whilst I received positive compliments from many sources, this did not include the NTA representative. I guess you cannot win them all.

I really enjoyed the conference and the organisers and participants should receive a big pat on the back. Andrea, you did a great job! Ian and Irene, you've done so much you should be proud of. All three of you, a real pleasure to spend time with you.

Let's keep the agenda moving forward.

My mate Kev

2008-09-12T06:25:00.003+01:00

You know, one sometimes forget how far someone has come to be where they are today. I am guilty of that sometimes with Kevin Manley, who works with as at Wired In. It is easy to forget Kevin's story when you see him bustling away at work.

Officially, we call Kevin our Community Development Co-ordinator. What this means in practice is that he does a wide variety of jobs. In the (real-world) community, Kevin is helping run the new Wired In Recovery Group in Cardiff, as well as spread the message about recovery, and act as a role model.

He is preparing and loading content on to the new community website, as well as write his own Blog. He is shooting and editing film, and uploading video to our YouTube and Vimeo channels. He has acted in our films shot by Jonathan Kerr-Smith. He is learning to operate the new content management system for the website, and playing around with a variety of social networking tools. And I am sure he does various other things I have forgotten about.

Most importantly, Kevin manages his recovery.

What versatility, eh! He has come an awfully long way from the days when he was fixated on getting his next fix. I am really proud to be associated with my mate Kev.

Just make sure you don't overdo it, Kev!

Brian's Personal Story - and computer programming bugs

2008-09-09T20:53:00.007+01:00

Whilst I was editing and loading more content for the new website today, I worked on Brian's Personal Story, which moved me greatly.

It's been fun and games today. As we work on the website, we find little bugs, which is exactly what you would expect with a newly programmed system. Fortunately, I spent a good deal of time computer programming when I ran my neuroscience lab, so I can understand that such glitches can occur. And we always accepted that there were 2% of glitches that were unexplainable. Actually, they were explainable, the god of computer programmes likes to have a laugh! And makes them illogical and unsolvable - or you have to do something outrageously counter-intuitive.

We've had a few glitches today. Why does a file truncate when we have more than one capital letter? And why does text suddenly turn red, unexplainably? It's all part of the rich tapestry of setting up a new content management system.

Now back to that Personal Story. Brian is one of the new volunteers in the Cardiff Recovery community. He's a real dynamo! Please read his story and let us know what you think.

A Parents Story

2008-09-08T18:54:00.003+01:00

I've had a busy time preparing and uploading material for the new website. I've been looking through content on our old 'substancemisuse.net' website, selecting what should be transfered to the new site.

I came across an old article given to me by Mike Blanche of Drug and Family Support (DAFS) based in Gwent. It was written by colleagues of Mike who asked if I would put it on our old website. I read the article and realised that it was as relevant today as it was when first written. There are many parents around the country experiencing the same problems today as were occurring five years ago.

As pointed out on my June 30th Blog, we are not devoting enough efforts towards helping family members who experience problems as a result of their loved one's substance use.

I leave you to read the article I have retrieved, called 'A Parents Story'.

What do we need for a revolution?

2008-09-07T08:06:00.009+01:00

I've just finished reading a fascinating book about cycling, entitled 'Heroes, Villains and Velodromes: Chris Hoy and Britain's Track Cycling Revolution' by Richard Moore.

In the spring, some of you may have watched what many believe was the greatest weekend of British sport ever. It was amazing to see our track cyclists win nine gold medals, more than half of those available, at the World Championships in Manchester. Only recently, we won most of the medals at the Olympics, with the unassuming Scotsman Chris Hoy winning three gold medals.

I was fascinated with the question as to how a country that had been ridiculed as track cyclists only 15 years ago could become the super-nation of the sport, holding a psychological stranglehold over the world. One thing for sure, it was not drugs.

The book I was reading told me what I expected - there were many factors that contributed to this success. The visionary Peter Keen who drew up a plan to make British cyclists competitive and then take them to the top. Other key players in his management team:

Dave Brailsford (now in charge, with his excellent business mind),

Shane Sutton (a great people manager, totally devoted to the cyclists),

Steve Peters (the clinical psychiatrist, who works with individual cyclists to help bring out their best),

Chris Boardman (former cyclist, super technologist and boss of the Super Squirrel club, all the revolutionary gear that helps performance),

The rest of the support team, including coaches, mechanics and masseurs,

And the cyclists (who are not just individuals, but who also support each other, with the more senior cyclists acting as mentors of others).

Then of course there was the money the UK Lottery provided and a total commitment to a team spirit and to being the best. And the wanting to get that 1% extra out of everything, from putting on a wheel to lifting that extra weight.

But then there was one last thing that Richard Moore describes at the end of his book: 'And sheer, undiluted, unrestrained enthusiasm - from Brailsford to Hoy to the coaches, mechanics and masseurs - seems to be a crucial element in the chemistry of the British team, perhaps the crucial element, permeating the entire squad...'

Yes, enthusiasm!

You know, that is something that I see in the treatment agencies I visit that are doing well with their clients. Enthusiasm!! It permeates these agencies. However, there seems to be little enthusiasm in the substance use treatment field as a whole, particularly in the upper echelons that 'manage' the field. It's time for that to change!!

I know I've been talking about a national cycling team and the factors that have made it great. And you might think that is very different to the treatment field. But are those factors different? Of course there are major differences in what is required to create best performance from elite cyclists (and developing a system to bring through talent) to helping people overcome problems. But there are many common elements.

It is time to change this field, from being one that is often ridiculed to one that becomes the envy of other fields. It is time to draw up a ten year plan and programme of activities. To bring together key elements that will allow us to transform the way that we help people overcome serious substance use problems. They did it in cycling, we can do it a field of social and health care. Let's take the Peter Keen vision as an example of what can be achieved.

The Recovery Movement is underway.

The upcoming recovery community website

2008-09-04T21:37:00.002+01:00

Today, I put up my big Mac screen in the living room so that I could show Lucie and Kevin how to work the content management system that will drive the recovery community site. It was fun! We're getting excited, although there is a lot of content still to prepare and upload. A period of testing will follow - some of you will be contacted and asked to help us track the bugs!

Then, of course, I'm going to have to get out there and raise sponsorship to help us maintain the site. Wish me luck! Feel a bit like Kevin Costner in 'Field of Dreams'. You'll know what I mean if you have see that excellent film. Please do join up to the community and participate in activities when we launch. It will be worthwhile!

My good friends Claire and Ian at CJ Wellings

2008-09-03T21:51:00.003+01:00

Claire and Ian of CJ Wellings, the publishers of Drink and Drugs News, came up to Cardiff to see us last Thursday. Lucie and I picked them up at the station and drove them out to Cowbridge so that they could see the Wired In headquarters and meet my beloved dog Tessa. We also had a tasty pub lunch.

It is amazing to think that DDN has been running for nearly four years. It seems a lot less time has passed since Simon Shepherd (formerly CEO of FDAP) and I did some plotting with Claire and Ian as they made the decision to set up on their own and launch a new magazine. And what a magazine it has been - and continues to be! I am certainly very proud to be associated with DDN and CJ Wellings. It is also a great pleasure to work with such nice people, who are committed to helping people affected by substance use problems.

Of course, lunch was not just lunch. The four of us did some thinking about how we can help each other over the coming year or two. More plotting afoot.

The only sad aspect was that Claire and Ian could not meet Kevin who was down with the lurgy. They'll just have to come up again soon! And hope it does not rain!!

Feeling lost

2008-09-02T17:48:00.004+01:00

"A long-tenured addictions counselor sheepishly shared that he was leaving the field—that it was getting harder and harder for him to feel good about what he was doing. He elaborated as follows, "Something got lost on our way to becoming professionals—maybe our heart. I feel like I’m working in a system today that cares more about a progress note signed by the right color of ink than whether my clients are really making progress toward recovery. I feel like too many treatment organizations have become people and paper processing systems rather than places where people transform their lives. Too much of our time is spent fighting for another day or a couple of extra sessions for our clients. I’m drowning in paper. We’re forgetting what this whole thing is about. It’s not about days or sessions or about this form or that form, and it’s not about dollars; it’s about RECOVERY!"" From: Linking Addiction Treatment & Communities of Recovery: A Primer for Addiction Counselors and Recovery Coaches by William White and Ernest Kurtz

Anyone felt like this? Or heard something similar?

Addictions Counselling Degree

2008-09-01T18:26:00.005+01:00

When I worked in a university, I always vowed that I would never become an external examiner. I considered it a mug's game, since the pain of reading so many scripts, sitting through boring meetings, writing reports etc, just wasn't worth the money you were paid. For those people who said I should be helping the university system - what, help make it easier for students to get higher grade degrees with no more talent, ability or work, and pretend this wasn't happening - I did not wish to to be a hypocrite. And besides, I did a lot of positive things for the academic system.

So it was with some trepidation that I agreed to act as External Examiner for the Foundation Degree on Addictions Counselling run by Action on Addiction and the Division for Lifelong Learning at the University of Bath. Nick Barton and Tim Leighton, of Clouds as it was then, obviously knew how to get around me. They not only got me to agree to be the external assessor for the development of the Foundation degree, and then External Examiner, but then External Examiner for the Honours Degree. External examining for four years!

Last Wednesday, I finished serving the maximum time that I could and, with some sadness, handed over to a new External Examiner, Dr. David Best. A great choice of successor!

It really has been a pleasure working with the Action on Addiction and University of Bath teams. I pointed out early on the amount of work covered in the Foundation degree (2 years) was far more than a normal 3-year Honours degree. And some of the students were exceptional. I was really amazed how much work the Action on Addiction team put into the course, and in helping and stimulating the students. The situation was so very different to what I experienced at Swansea University, where members of my department spent so much time moaning about and trying to reduce their work load.

Well done Derrick, Tim and the team. I could say I'll miss you, but I know I am going to be seeing lots more of you (and Nick and Kirby), hopefully collaborating on a variety of new initiatives. Let's have some more fun! Good luck for the future!!

New Seminal Monograph from William L White

2008-08-31T17:26:00.008+01:00

I'm back after a period of looking after my three youngest children during their summer visit - and a period of recovery!

I have just received notification from William L White of his new publication, 'Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices', that has just gone to press and can be downloaded from the Faces and Voices of Recovery website. As pointed out by Arthur C. Evans in his Prologue, this monograph will be regarded as a seminal work in the addictions treatment literature, as it is the most comprehensive attempt to lay out the empirical support for moving to recovery-oriented systems of care.

In America, there is a major shift in thinking about how we must help people overcome serious substance use problems. There is a shift away from focusing on the problem (addiction) to focusing on the lived solution (long-term addiction recovery). There is also 'a shift away from crisis-oriented, professionally directed, acute-care approach with its emphasis on isolated treatment episodes, to a recovery management approach that provides long-term supports and recognizes the many pathways to healing.'

This approach is key to society improving long-term outcomes of addiction treatment. We in the UK have no option but to follow the approach being adopted in America. Our overall success as a nation in helping people overcome serious substance use problems and find recovery has been disappointing over recent years, despite a significant investment in funding from government.

Whilst a shift to a recovery-oriented system of care represents a major challenge for this country, we are very fortunate in being able to read the writings of Bill White and implement the changes that are being advocated. White is providing a framework that can be used to guide the planning of policy makers and help them understand the key issues that must be addressed.

I urge people working in this field to read this seminal monograph! There is a lot to take in and think about, but the people suffering from substance use problems deserve us devoting the attention that is needed.

Therapeutic principles underlying behavioural change and recovery

2008-08-18T19:58:00.002+01:00

What are the key therapeutic principles that underlie behavioural change and recovery? Here are some of my reflections on this issue. These principles need to be an integral part of any treatment programme that aims to help people find their path to recovery. What do you think?

Reflections on Treatment

2008-08-17T19:33:00.002+01:00

Firstly, if you were waiting for my Blogs in the second part of the week, my apologies. My three youngest children have come to stay with me for their summer holidays, before moving abroad with their mother. I will also be wanting to spend as much time as possible with them this week.

Last week, I reflected on recovery and pointed out that formal treatment was one form of help that can help a person move along their path to recovery. I attach a short document which outlines some other thoughts about treatment.

Some Words on Recovery

2008-08-12T17:50:00.003+01:00

I had a nice comment on yesterday's Blog - thanks Mike! He went on to say that he will be sending my Blog to his boss at the DAAT where he works as the latter is 'striving to develop his understanding of the whole recovery debate.' I have often wondered how many DAAT teams read my Blogs - and how many understand the concept of recovery.

Following on from yesterday's Blog on 'drug, set and setting', I have linked to a short document that I wrote some months ago on recovery from heroin addiction. Hope you find it useful. I am writing much more detailed material on recovery for our forthcoming online community site. Stay tuned.

The role of 'drug, the person and their social context' in the development of problematic drug use and recovery

2008-08-11T22:53:00.007+01:00

In yesterday's Blog, I pointed out that the effects of a drug (or alcohol) on an individual are determined by an interaction between the drug, the person and their social context (commonly known as 'drug, set and setting' in the field). This principal holds in a variety of situations.

For example, the ‘person’ and ‘social context’ factors influence early substance use and the likelihood that a person will develop problematic use and addiction. In general, individuals are less likely to develop substance use problems if they have fewer complicating life problems, more resources (social, personal, educational, economic), and opportunities for alternative sources of reward. One explanation is that these individuals develop a weaker attachment to the substance in that for them substance use does not serve as many emotional, psychological or social needs.

On the other hand, people are in general more likely to develop substance use problems if they have complicated personal problems (e.g. co-occurring mental health issues), few personal resources, and live in a deprived social environment offering few alternative rewards.

Serious substance use problems often occur as part of a larger cluster of psychological, medical, family and social problems. However, it must be remembered that addiction can affect anyone, whatever their age, gender, financial situation, family stability, intellect, religion, or race.

A variety of factors can change problematic substance use once it has developed. For some people, the problems are transitional in nature and they mature out of them as their setting changes, e.g. other life events become more significant, such as setting up a home with a loved one. Other people spend years misusing substances and suffering negative consequences and losses, before dying without overcoming their problems. Most people, however, experience multiple attempts either to stop using or to bring their use under better control before they eventually resolve their substance use problems.

The ease with which people overcome substance use problems, and achieve recovery from addiction, is largely dependent on two factors, namely problem severity and recovery capital. Recovery capital is the quantity and quality of internal (‘person’) and external (‘social context’) resources that one can bring to bear on the initiation and maintenance of recovery. The interaction of problem severity and recovery capital shapes both the prospects of recovery and the intensity and duration of resources (e.g. formal treatment) required to initiate and sustain recovery.

In general, it is easier to resolve substance use problems at earlier and less severe stages of problem development. Moreover, substance use problems are easier to overcome if a person has good internal and external resources.

The Vietnam War Experience

2008-08-10T20:21:00.006+01:00

Most people assume that the effects of psychoactive drugs are fixed and predictable, being dependent on their physiological actions in the brain. In fact, the psychological effects of a drug are also dependent on a variety of characteristics of the individual, as well as the influence of the social context in which the drug is taken. In the field, this is known as 'drug, set and setting'.

If we are to better understand the impact of drugs and alcohol on the lives of individuals, and help them find their path to recovery from addiction, then we need to appreciate the importance of 'drug, set and setting'. Sadly, this is not a widely appreciated fact in the field.

Many people assume that once you have tried heroin you become addicted to the drug. It is also commonly assumed that it is extremely difficult to give up using heroin. Whilst this may be the case for many people, it is not for many others. The most dramatic illustration of this point, and of the role of 'setting' in addiction and recovery, is provided by research conducted with US soldiers returning from the Vietnam War.

Please read about this fascinating research study in the attached short document.

The 100th Posting

2008-08-06T22:01:00.006+01:00

So this is it, the 100th post on this Blog. Not quite my 100th, since Lucie and Kevin posted some material whilst I was on holiday, but all the same I feel chuffed.

For regular readers, you will know that my colleagues and I at Wired In are committed to radically altering the way that society helps people overcome serious substance use problems. We are strong recovery advocates. We aim to show people affected by serious substance use problems and addiction how others have found their path to recovery. We want to help create a society that is more understanding of addiction and provides a better environment for individuals and families trying to find recovery.

I would like to use three quotes in this 100th posting, quotes that have influenced the way that I think about this field. The first two quotes are from the Tom Peters book, 'Re-imagine!', a book that has nothing to do with substance use problems.

'Some people look for things that went wrong and try to fix them. I look for things that went right and try to build on them.' Bob Stone

'Find Heroes. Do Demos. Tell Stories'

The final quote is one I have used before, from 'Slaying the Dragon: The History of Addiction Treatment and Recovery in America' by William L. White.

'In the future, this locus will be shifted from the institution to the community itself. Treatment will be something that happens in indigenous networks of recovering people that exist within the broader community. The shift will be from the emotional and cognitive processes of the client to the client’s relationships in a social environment. With this shift will come an expansion of the role of clinician to encompass skills in community organization. Such a transition does not deny the importance of the reconstruction of personal identity and other cognitive and emotional processes – or of the physical; processes of healing – in addiction recovery. But it does recognize that such processes unfold within a social ecosystem and that this ecosystem, as much as the risk and resiliency factors in the individual, tips the scales toward recovery or continued self-destruction.'

Aims of our Upcoming Online Recovery Community

2008-08-05T21:47:00.005+01:00

Yesterday, I reported progress on our new web community site which we expect to launch at www.wired.org.uk in the autumn. I was re-reading a section of Bill White's paper, 'The Rhetoric of Recovery Advocacy: An Essay on the Power of Language' today, the part that focuses on the goals of the new Recovery Movement in America. I was reminded that the aims of our new community site are very similar to those described by Bill White in his manuscript.

1. To show that there are many diverse pathways to recovery from serious substance use problems and addiction.

2. To provide living role models who illustrate the diverse range of recovery solutions.

3. To provide information and tools to help people find recovery using: (a) their own personal psychological resources; (b) the support and help of loved ones and friends, and (c) community-based treatment and other support services.

4. To help reduce prejudice towards substance misusers and their families, to create a society that is more understanding and supportive of recovery from substance use problems.

5. To enhance the variety, availability and quality of recovery support services at local, national and international levels.

Please get involved in our new web community!

I've now launched the 'Wired In to Recovery' channel on vimeo which provides higher quality video than on YouTube. Check out our first three film clips. And why not subscribe so you can be updated each time we launch more material?

The Upcoming Wired In Online Recovery Community: An Update on Progress

2008-08-05T01:26:00.005+01:00

I was thrilled on Friday to receive an email from Nathan Pitman of Nine Four to say that I can start loading content onto our new website, which will be located at www.wiredin.org.uk. He has completed a good deal of work on our content management system.

This doesn't mean that the website will be ready for viewing in the near future, as we have lots of content to load and much testing to do. However, it will be ready sometime in the autumn. Some of our close colleagues will be getting an earlier sneak preview and helping us trouble shoot.

The new website will be an online recovery community, a place where people can meet and interact, learn about recovery and addiction, contribute content, and help others. We will be offering personal web pages where you can show your personal profile, write a Blog, and get involved in other activities. The best of the material generated by our community members will be highlighted on one of three channel pages - Users/Ex-Users, Families and Practitioners - and on Daily Dose. We will be using a variety of social networking tools to get more people involved from around the world.

I am so excited as I have been dreaming about this online community ever since I first read Amy Jo Kim's excellent book on web communities seven years. Have tried to get funding to set up and maintain a community in the past, but no such luck.

There is no doubt that this web community can be very special, helping people affected by substance use problems and acting as a recovery advocacy centre to improve and widen the understanding of recovery and addiction in society. However, its success will depend on you!

Nathan will be posting sneak previews of the site on our Flickr pages. I have also attached a short video on recovery from our recently set up vimeo channel.

If you want to be informed of our latest news, you can sign up to an RSS feed on the right side of this Blog.

PS. I should point that whilst I have some money to fund the initial development of this online community, I need to raise a good deal of funding to keep it maintained. I start making approaches to potential sponsors or other funders when my children finish their holiday visit with me in a few weeks time. Wish me luck!!

Watch Mike Ashton talking about addiction and recovery

2008-08-03T14:55:00.008+01:00

I recently watched some film clips of Mike Ashton, a leading researcher taking part in the Lifeline film series, which re-emphasised to me the unjust way that society treats people with a drug problem. And helps exacerbate the drug problem. I can strongly recommend a quick look at Mike's film clips.

In society today, we have a climate that works against people overcoming drug use problems. We stigmatise people with a drug problem, in particular those who use heroin. We criminalise users and make it more difficult for them to find social support, housing and a job. We make it more difficult for them to access treatment by placing the treatment system within the criminal justice system - many users feel they will be stigmatised by accessing this system. The leader of the National Treatment Agency even tells problematic drug users that the only reason the government is interested in helping them is because heroin users are a threat to society because of the crime they commit.

People with a drug problem are often told that they have a chronic relapsing condition (addiction) and given little hope that they can overcome their problem. The social capital that they require to help them on the path to recovery has often been stripped away - as a society we contribute to this stripping away, and do not help alleviate the situation as much as we could.

People with drug and alcohol problems need to help themselves in finding their path to recovery. However, it is very much easier for them to do this when they have the understanding and support of people close to them and in the wider community.

Stimulation in Scotland

2008-07-31T21:40:00.005+01:00

I have just returned from an enjoyable two days north of the border, in my favourite part of the UK. Yesterday morning, I had an excellent meeting with Joe Griffin, Head of the Drugs Policy Unit of the Scottish Government, and two of his colleagues. We talked a good deal about the Scottish drug strategy and their focus on recovery. It was a really refreshing discussion!

Joe and his colleagues are fully aware of the big gap there is between having a strategy and implementing it - in a way that maximises chances of success as well. The Scottish Government has taken on a major challenge - a really exciting one - in breaking away from the standard approach that has been in operation in the UK in recent years. I was given quite a grilling about a variety of issues relevant to the recovery agenda and I was thrilled that I was being asked so many of the key questions. I was impressed.

I then took a bus down to Melrose - an Abbey and a rugby ground, oh and some houses - which is in a lovely part of the country. A super bus trip. I had dinner with my daughter and her boyfriend, both who are doing a period of medical training at the local hospital.

I spent most of the next day at the LEAP project in Edinburgh. Good to catch up with David McCartney and his lead therapist Eddy Conroy, both who are great guys. I also met Annemarie Ward from the west coast of Scotland for the first time - we have emailed, phoned and skyped a great deal in the past months. I was really impressed by how easily the clients at LEAP all took to Annemarie - wish I had that charm. I chatted with a number of the aftercare clients and then attended a meeting with the treatment programme clients. It was all very moving, reminding me again how lucky I am to be working in this field.

I ended up having a good chat with Eddy about the importance of community and related factors in recovery. It's always good to talk with someone so knowledgeable and passionate.

Cannot wait to spend more time north of the border - and I have got a lot of food for thought.

Have a good weekend all.

Wired In Tenpin Bowling

2008-07-29T21:23:00.004+01:00

I had an excellent afternoon bowling with members of the Wired In team, including some of our volunteers. It was really pleasing to interact with members of the Cardiff community that Lucie and Kevin have been developing.

The current Wired In bowling champion Mark Saunders was in fantastic spirits, although he had left his bowling skills at home. I continue to be amazed by Mark's progress since I first met him and he was truly buzzing today. He epitomises the Wired In positive spirit.

Chris Hobbs came along with his partner Sian and their lovely little boy, Michael. I'm afraid Chris tends to twist his body and his balls regularly miss the pins - and the lane! Still, there is good room for improvement!! Sian was way ahead of Chris, but not up to the standards of the other ladies. Maybe they can both blame Michael.

It was great to finally meet David Wright - we have emailed each a lot and spoken on the phone, but never gotten together. David was cheering wildly for our team - boy, did we need it! I really took to David and no doubt we will get together and have many long discussions.

Kevin Manley had all the power and some direction, but was not consistent enough. I feel so proud of what Kevin has achieved since he joined our team. He is a real inspiration to so many people in Cardiff and further afield.

I met Patrick M for the first time. He had a real sparkle in his eyes, particularly when he was striking out! He was close to winning the first game, but lost out to our University graduate volunteer Ross Asquith. I spoke to Ross's brother Lewis the other day - he is my personal trainer - and he says she is really hooked to working with our community. It's great to see.

Lucie was Lucie - if you know her, you'll know what I mean. Her real joy - shared by us all - was three strikes in a row on her last three throws of the afternoon. Not enough to win though, as Ross won a second time.

Kerry Manley started with a run of strikes and spares - we thought she had been hiding her talents. Sadly, Kerry fizzled out as time went on. Maybe, she just wanted to give us a chance. It's lovely that Kerry finds time to come out with the team. She has been through so much during the 15 years of Kevin's addiction problems, so it is so nice seeing her in such good spirits now.

As for my bowling - I'll say no more, other than it was awful.

Congratulations to Ross! But don't think you are going to stay as Wired In champion. Competition will be much tougher next time.

I felt so proud being with the Wired In Cardiff community today. It was so rewarding to see a bunch of happy faces, belonging to people who have been through so much.

'Less division, more reform', rightly calls Mike Trace

2008-07-28T20:01:00.009+01:00

I was very pleased to see Mike Trace’s erudite letter in Drink and Drugs News, ‘Less division, more reform’. Mike expressed a concern that much of the debate on abstinence and harm reduction he has been reading on the letters page of DDN has been based on the ‘‘either/or’ language of the 1980s’.

I would agree with Mike – in fact, I would go further and say that I have read and heard too much of this ‘black-white’ debate not just in DDN, but in other places, and for a long period of time. It has intensified recently with the greater interest being shown in recovery. However, as I have said in earlier blogs, an interest in recovery does not preclude an interest in methadone prescribing and harm reduction practices. They are not mutually exclusive!

As Mike points out, what is needed is a menu of services in each geographical area - encompassing outreach, harm reduction, and various forms of structured drug-free and prescribing-based treatments - that provide accessible and good quality care for drug users that is appropriate to their wants and needs.

‘The vision was that any drug user would be motivated and supported to change their behaviour in ways that suited their individual needs and circumstances, whether that be immediate life-saving or health protection measures, help to stabilise their use and behaviour, or help to make significant changes or cease their drug use, and reintegrate into family and community life.’

Mike points out, quite rightly that in the UK it ‘is far easier for drug users seeking treatment to access substitute prescribing services than it is for them to go into structured drug free programmes. This is not an appropriate situation where more than half of the target population are not primary opiate users, and most want eventually give up drugs. Furthermore, too many referral and placement decisions are being made on the basis of what is available, or the preferences of the assessing authority, rather than the needs and wishes of the user. This is what needs to change.’

I agree wholeheartedly with these sentiments.

Mike Trace then goes on to point out that these shortcomings should not be seen as failures – as I've said on many occasions, we cannot get it all right in one go – but as challenges for the future.

However, he is concerned ‘that those who are responsible for managing the treatment system themselves fall into this ‘either/or’ mentality, or seek to defend the status quo. This is a surefireway of inviting increased disillusion from policy makers and the public about the vast amounts spent on our sector – disillusion that will eventually result in bad policy or serious disinvestment.’

Again, I agree wholeheartedly.

Mike ends with a call, which I for one support – ‘So please, lets expend less energy on dividing into camps and swapping arguments, and devote a bit more time to the reforms necessary to achieve an integrated treatment system that balances the best of all effective services.’

What do you think?

PS. Please excuse me for such liberal quotes, but why reinvent the wheel. Mike Trace has put over very well a view which we need to take seriously – please read his full letter in DDN.

The National Drug Strategy: a guide for local partnerships

2008-07-24T17:52:00.004+01:00

Another day of post-holiday catching up at Wired In, but at the end of day thought I better read something for this Blog. Turning to Daily Dose, I decided to tackle a document on Sara McGrail's Blog - with my jet-lagged brain.

Now, I knew the various elements involved in the implementation of the Drug Strategy are complicated, but after reading Sara and David MacKintosh's document, 'The National Drug Strategy: a guide for local partnerships', I realised that they are even more complicated than I had envisaged. I have to confess that I mightily glad that I am not involved in the process of delivering the drugs strategy at the commissioning level. Far too complicated for my brain!

It's bad enough thinking about being involved in that process - how on earth did anyone write about all the stuff involved? I am in admiration of what Sara and David have achieved with their document. Piecing all of that together in the way they have done involves a special brain (or two) - and they deserve a massive pat on the back.

So if you are involved in implementing the drug strategy in some way, it is important and worthwhile that you read this excellent document, so you can gain a better understanding of what is what - and all the nuts and bolts. Mind you, I cannot promise that your brain won't get fried like mine. I'm going to have to watch a mindless film now.

But well done Sara and David!

Lifeline's Film Project

2008-07-24T06:54:00.006+01:00

I spent all day yesterday catching up with Wired In things and planning for the future with Lucie, so there wasn’t a great chance for me to catch up with what has been happening in the wider field.

I did take the opportunity to look at the Lifeline Project film offering with Ian Wardle interviewing three professionals in the field - Dr David Best, Mike Ashton and Tim Leighton. I really enjoyed these film clips and I strongly recommend that you watch them. Well done, Ian, Maggie, and your interviewees! You certainly deserve to be the subject of my first post-Oz Blog!!

I was very interested in Ian’s selection of interviewees, because they are three of my favourite individuals in the field. They are leading the way in the quality of their research, thinking and writing – and they are not frightened to speak out and challenge others. This is so important in a field where there is so much spin, poor quality research, misleadings, amateurish efforts, poor level of understanding, top-down meddling, etc.

By speaking out regularly, as they do, Ian’s three interviewees are helping protect the rights of people affected by substance use problems, helping ensure they get better treatment, and helping those practitioners who are trying to make a positive difference in the field.

Strangely, I have never met David Best, although this will soon change. I have been to so many places where people have said, ‘You and David Best must get together, you are so alike, in your passion, your caring and in what you are trying to do.’ I have to say I could see that passion full-on in the Lifeline film clips – and David also has a wicked gleam in his eyes. Well, David and have been doing a good bit of talking together recently and we will soon meet. We are also planning a research project with some other leading researchers, assuming we get the funding. Exciting times ahead!

The other two interviewees are the two most knowledgeable people I have met in the substance use field - the ‘fonts of all knowledge’. Mike Ashton, Editor of that great magazine (and website) Drug and Alcohol Findings, is also a member of the Wired In Advisory Board. I am often on the phone to ask Mike whether he knows of any research on so-and-so subject, or to get his opinion on such-and-such issue. He is such a thoughtful person (in both ways) and I really enjoy our discussions. I’ve changed some of my thinking following challenging discussions with Mike.

I’ve known Tim Leighton since I first became involved with the education programme at Clouds (now part of Action of Addiction). I played an external role in assessing the quality of the degree course they were setting up, and then acted as External Examiner for four years. During my periods of reading many exam scripts, Tim would bring in piles of new books and papers to see if I had read them. We would then get involved in wonderful discussions about a variety of topics before I would have to drag myself back to looking at the exam scripts. Tim recently came to my house for the afternoon for me to finish off some exam work and we spent some hours discussing recovery. We decided we must now have regular get-togethers to discuss key issues.

There are two other great things about these three guys. One is that we don’t always agree, and may even finish a discussion without agreement, but they always respect my opinion (I think), as I do theirs. There is a humbleness about them. And secondly, these three guys have big hearts and they care passionately about the people who are affected by substance use problems. I’ve learnt in this field that there is a very good correlation between how well I get along with someone – and the size of their heart.

Please go watch these film clips. There’s some straight and important talking there.

Back from Australia

2008-07-23T06:07:00.008+01:00

Have returned from holiday in West Australia, where I had a relaxing and very enjoyable time. I will resume normal blogging tomorrow.

Meanwhile, I would like to thank Lucie James and Kevin Manley for maintaining my Blog whilst I was away. It's great to know that you can go away and leave your Blog in good hands.

I'd also like to thank all those who contributed to the 'What Recovery Means to Me' series run by Lucie on this Blog. I really enjoyed reading and watching the contributions by Patrick M, Brian White, Chris Ling, Kerry Manley, Sean Rendall, Chris G, Annemarie and Mark Saunders. If you haven't already, please take the opportunity to read and watch!

I am also very pleased with the continuing film work that Lucie, Kevin and Jon Kerr-Smith have posted on our You Tube channel. Kevin's piece of film that he created on the Mac I gave him to play around with is super. Well done Brian White and Kevin for the excellent 'Reflections on my journey into recovery'!

Benefit clampdown on heroin and crack users

2008-07-21T16:59:00.005+01:00

I (Kevin) read with interest, yesterday's Daily Dose that highlighted the recent announcement of a benefits clampdown on heroin and crack addicts. It seems that the numbers of addicts in this country who are receiving benefits, could be as high as 300,000 people.

While I like the idea of more people being offered treatment, I think being forced into said treatment is a totally different ball-game. In fact it could even cost the tax payer more than just keeping people in benefits. In my experience, when people are forced into doing something they either don't want to or are not ready for, than usually it tends to fail and what happens then?

But I think I need to backtrack a little. Firstly, I'd like to know what kind of treatment is going to be on offer? At the moment treatment just seems to consist of a substitute prescription - is that what this is? A scheme to get more people on methadone against their will? To subdue them, keep them quiet and then forget about them!

If people are going to be offered a complete range of treatment options, and ongoing aftercare for as long as they need it, then great bring it on. But call me cynical if you like, when I say this just isn't going to happen. I fear this is just another second rate response geared to raking in more votes. Labour knows that the next general election is lost, and is once again announcing measures it is not going to be able to follow up on. Empty promises once again!

I hope this isn't the case and that it is going to be worthwhile venture - but my gut tells me differently! I'd like to know what the Daily Dose readers think of this announcement - please email me or leave your comments on the blog for everybody to see.

Opioid substitution treatment in jail - A practical guide

2008-07-17T17:38:00.004+01:00

Whilst Dave makes the most of his few remaining days in paradise, I (Kevin) thought I would discuss a topic I read with interest on yesterdays Daily Dose -

The guide, recently published by BIS-Verlag with the support from WHO and UNODC, aims at providing a reference document supporting prison doctors, prison health care workers, prison administration, NGOs and others in delivering or supporting substitution treatment to opioid dependent prisoners [Connections]

Well, what a step forward! I'd like to talk a little bit about my experiences of substitution treatment in prison. Before I entered jail in early 2003 I was being prescribed a mixture of drugs by my GP. I was on 50ml of methadone, 12x30ml dihydrocodiene and 60ml valium, everyday. On top of this I had recently started to use heroin again.

On entering Parc prison in Bridgend, I applied to see the Doctor. This took around 10 days to happen, during which time I was a right mess! When I got to the medical centre I told the Doctor that I was a heroin addict and had been receiving treatment from my GP. He told me there wasn't anything he could do for me. A bit shocked, I explained what my GP had prescribed me and asked for his help. He laughed in my face. At the time I figured he thought I was lying so I said that he could check it out with my GP. With that he held up a blank piece of A4 and said 'medical report'. He then put it in the shredder!

With that the prison officer took me back to the cell I was living in and that was that. I was ill for the next 2-3 months, suffering a couple of blackouts and the worst detox I have ever gone through. I could not believe it! Does the Hippocratic oath mean nothing?! That was my experience of prison opioid substitution treatment.

Yes of course a practical guide for prison Doctors, nurses etc is a good thing. The guide itself (what I've read of it - well it is quite long!) is coming from the right direction and has solid advice in it. But all of that is for nothing, if the prison Doctor doesn't want to follow it. The guide will just go in the shredder!

What Recovery Means To Me - Patrick M

2008-07-15T19:15:00.002+01:00

Today is the last day of the ‘What Recovery Means To Me’ series. First off I would like to sincerely thank all those who have participated and had the courage to share their views with others. The strength of character that you all show amazes me, and I feel privileged to have had the opportunity to learn from you.

To conclude the series we will hear from Patrick M about ‘What Recovery Means To Me’. Patrick has been a Wired In volunteer for about seven months and has taught me a lot about the role of positive thinking – I marvel at his positive outlook on life, and how he tackles his problems head on and with a smile on his face! You can learn more about Patrick, and our other volunteers, in the Our Community blogspot.

What Recovery Means To Me - Brian White

2008-07-14T16:40:00.001+01:00

Last summer Wired In went to a drugs project in Swansea to do some filming with their clients. At the end of the day, just as we were packing up, we got chatting to a guy named Brian White. Not long into the chat I realised that Brian had a very powerful story to tell. The camera got switched on and an impromptu conversation was filmed!

Whenever Wired In does filming we always try our hardest to find those who were involved to show them their edited footage. Normally this is a relatively easy task. But not with Brian! I spent over six months trying to track down Brian – asking at local homeless hostels, drug agencies and even every Big Issue seller I came across! Brian’s film work had really impacted upon me –the footage was very raw and emotional. To be honest, I was quite worried about what had happened to Brian due to the chaotic nature of his life at the time.

Then, at the start of 2008, I bumped into Brian on a treatment program in Cardiff. But, I barely recognised him. Not only was he looking much healthier, there seemed to be a peacefulness about him. He seemed very comfortable with himself. Watching through his footage together was quite emotional for us both! Brian had come so far, and I think the footage helped him to realise exactly how much he had changed.

Since that day we have worked very closely with Brian and it has been an absolute pleasure to see the many changes in him. Brian wanted to share his views on ‘What Recovery Means To Me’ although he did reiterate that to him recovery is quite simple – he now has a life.

Last week we also did some filming with Brian – almost an update on his life and how things have changed. I’m sure you too will see the differences in Brian between the filmed series ‘Life as a Heroin Addict’, and his recent work, ‘Reflection of my journey into recovery’.

What Recovery Means To Me - Chris Ling

2008-07-13T19:45:00.003+01:00

Everyone has a different approach to life, and the same can be said about people’s approaches to recovery. The recovery journey of Wired In volunteer Chris Ling is an approach that I will never forget.

Chris has literally taken life by the horns since entering treatment for alcohol addiction ten months ago. I meet Chris on a weekly basis, and rarely a week goes by where he hasn’t completed a course or applied for voluntary work that will help him achieve his dream of working in the substance misuse field. His caring nature and passion for helping others is lovely to see, and I am sure he will be an asset to this field.

The positive outlook that Chris has towards life and his future is truly inspiring – although I have no idea where he gets his energy from! Chris jumped at the chance to share his views on recovery, and we decided to have a go at filming our discussion. Please take a look at Chris’s views on ‘What Recovery Means To Me’.

You can learn more about Chris Ling and his journey through addiction and recovery in Our Community. Feel free to share your comments and experiences with us.

What Recovery Means To Me - Kerry Manley

2008-07-10T17:03:00.007+01:00

When addiction strikes a loved one, the consequences are often severe for the rest of the family. They have to watch as someone they love changes into something they can hardly recognise. Feelings of helplessness, worry, even anger for what the rest of the family is going through, are the norm.

Kerry Manley first decided to get involved with Wired In after her son, Kevin, became a volunteer with us. That was over two years ago now, and we have had the pleasure of watching Kerry and Kevin rebuild their lives and their relationship.

Kerry volunteers with Wired In as she wants to help other family members understand more about addiction. But most importantly she wants to give others hope that addiction can be overcome and life can go on. Kerry has filmed her personal story with us, in conjunction with Kevin, and has also done other filmed and written projects with us. For more information about Kerry, and her experiences of addiction and recovery, please visit Our Community.

When you meet Kerry, you instantly realise what a gentle, loving person she is. It is also evident that what she went through with her son impacted on her greatly. Here she talks about a happier topic, that of ‘What Recovery Means To Me’. Feel free to comment and share your experiences and views with us.

What Recovery Means To Me - Sean Rendall

2008-07-09T15:38:00.003+01:00

Last week I was sent an attachment that I felt was spot-on for helping people to understand addiction and recovery. It was an Addiction Tree, sent to me by Sean Rendell. This simple, yet powerful illustration shows the many components that need to be understood and/or dealt with for addiction to be overcome.

The Addiction Tree illustrates how much help and support people need when addressing their substance use. It can be easy to just focus on the substance use itself, but there are so many other areas and components that need to be dealt with. To me, this emphasises the need for readily available long-term, diverse and intensive help and support – and not just for those lucky few!

Alongside sending me the Addiction Tree, Sean also sent me his views on ‘What Recovery Means To Me’. Again, I have been blown away and humbled by such an honest and inspirational account. I hope you enjoy Sean’s article, and please share your views and experiences.

What Recovery Means To Me - Chris G

2008-07-08T17:55:00.001+01:00

Ten months ago I received an email from a guy called Chris G. He was asking if he could write something to be published on Daily Dose – he wanted to thank his key worker for all her hard work in helping him to stop using cocaine. Although we were unable to do that (for fear of being inundated by others!), Chris became a much valued Wired In volunteer.

I have worked very closely with Chris over the last ten months, albeit from a distance as he lives in Luton. It has been a pleasure getting to know Chris over this period, seeing the many changes he has made and watching him grow as a person. There have been many ups and downs in his recovery, but he has battled through and learnt to deal with what life has thrown at him. He has been an inspiration to me and many others.

When I mentioned to Chris about the ‘What Recovery Means To Me’ series he jumped at the chance to share his view of recovery. Within the hour he had sent me his article - ready and waiting! I hope that you enjoy reading Chris’s views on recovery – please comment or share with us your views.

You can learn more about Chris G in the Our Community blogspot, where some of his other work is displayed. His personal story is soon to be completed so watch this space!

What Recovery Means To Me - Annemarie

2008-07-07T20:19:00.002+01:00

When I first left university I thought I knew it all! I’d done the addictions module (courtesy of the Prof) and I thought I had a good grasp on what addiction was and how it affected people. How wrong could I be!

Through Wired In I have worked closely with a number of people with substance misuse problems. I have been fortunate in that I have also worked closely with a lot of people in recovery. I appreciate that not all workers in this field get this opportunity – which is one of the main reasons for running the ‘What Recovery Means To Me’ series.

I think that it is so important that people working in this field get a better understanding of long-term recovery, so that they can help their clients find their path to recovery, and support them in the long-term. There is no quick fix solution to addiction, but with a better understanding we can help people achieve a stable, happy and fulfilling life in recovery.

After three years of working for Wired In I still find that every day is full of new surprises. There’s always something new to learn. The Wired In volunteers have been a fountain of knowledge to me. I could sit there for hours listening to their views and experiences of addiction and recovery. They are all such caring, talented and enthusiastic people, who desperately want to help others realise that recovery from addiction is possible.

Today we will hear from Anne Marie as she shares with us ‘What Recovery Means To Me’. Please feel free to comment or share your own opinions or experiences.

What Recovery Means To Me - Mark Saunders

2008-07-06T18:35:00.006+01:00

Whilst Dave is away sunning himself in Northern Australia, he has relinquished control of his blog to Kevin and I (Lucie). We thought long and hard about what we could do (and the possible consequences of some of those actions!) and finally decided that we would do a series of blogs entitled ‘What Recovery Means To Me’.

Over the next week and a half we are going to talk to a number of people who are in recovery, and provide a platform from which they can share their views and experiences with you. We strongly encourage others to post comments on these blogs, and share with us what recovery means to you – the good, the bad and the ugly!

We hope that this blog series will encourage discussion and debate about what recovery means, and how the experiences of people in recovery can be used to help others find their path to recovery.

The ‘What Recovery Means To Me’ series will kick off with the views of Wired In volunteer, Mark Saunders. Once you have read Marks views on recovery please take some time to look around his filmed and written work in Our Community.

P.S. The latest Wired In film footage has been launched, this week focusing on people's views on waiting lists for treatment.

The Coming Revolution: But First, Holiday Time for DC

2008-07-03T14:52:00.013+01:00

'Recovery is the experience (a process and a sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD-related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life.' William L White, 'Addiction recovery: Its definition and conceptual boundaries' in Journal of Substance Abuse Treatment, 33: 229-241, 2007.

It has been an interesting, but sometimes frustrating, past few years working in this field. It has been rewarding, but sometimes annoying. Pleasurable, but often tiring. Challenging, no doubt.

There needs to be a revolution in the drug and alcohol treatment field, in the UK and further afield. A revolution that will markedly increase the number of people who find their path to recovery. One that will help professionals, recovering addicts, family members and many others become much better at helping others find recovery from addiction.

I know that Wired In can help instigate the major changes in the field that will see so many more people find their path to recovery. We can facilitate that revolution and maintain its momentum in a wide variety of ways.

However, I also know that what we are trying to do is a massive challenge, particularly as Wired In is a small team with minimal funding. I know that it will draw upon much of my and other peoples' energies to create and maintain the necessary changes. We need people to join up and help us - which is already occurring - and we must attract significant funding.

I know that the vision my colleagues and I have is attainable. The Recovery Movement will impact significantly. It will gain momentum, reach a tipping point and flourish in our communities. However, I also know that it will be a long and often hard journey, with many pitfalls ahead in the coming years. Have no illusions, the changes needed in society will take a long time to achieve - so we need to start now!

One of the significant obstacles to be faced is summed up by William L White: "... the greatest obstacle may well turn out to be the tendency for treatment professionals to declare they are already "recovery-oriented" or to mask treatment as usual behind a new recovery-focused rhetoric.' This is already happening in the UK. So it will be important to continually promote the true recovery cause.

If you are committed to seeing the changes I have been proposing over the past two months in my Blog, please contact us at lucie@wiredin.org.uk. If you want to help in any way, let us know. Remember, we are trying to develop an initial network of people who are committed to the recovery agenda. And we want to hear your recovery stories.

If you want to read more about recovery from addiction, then please take a look at my Background Briefings from Drink and Drugs News, beginning with the 'Helping People Towards Recovery' article and continuing through the articles above on this Blog. Also look at the extensive literature of William L White.

I'm on holiday in Perth, West Australia, my old home town. It has been so good to renew old acquaintances, relationships - 40 years on from when I left as a youngster. And now I am building new friendships, relationships and networks ... that will also facilitate the Wired In agenda, to help people overcome substance use problems.

But for now, I am focusing on my holiday within a holiday, starting tomorrow. I am flying to Broome, in the North West of Australia. Sun, sea, rest and peace.

So I am handing the Blog over to Lucie and Kevin...

Byeee and see you soon. David.

Wired In Recovery Community, South Wales

2008-07-02T16:06:00.002+01:00

It gives me such a pleasure working in this field, in particular working with people who have overcome or are trying to overcome serious substance use problems. Many of these people had life problems before they started to use substances – in fact, substances were often used to help them forget about or deal with these problems. They have often shown tremendous courage in their recovery efforts and in finding their path to recovery.

I am thrilled that Lucie James and Kevin Manley are developing a new Recovery Community in South Wales, members of which introduced themselves on a new Wired In Blog on Monday. Their individual pages contain personal introductions, Personal Stories and various other pieces of material. Some of these eight people have appeared in the Wired In film material.

Please take the opportunity to look through these Community Blogs. There is a lot of material that you will find of interest and may want to pass on to others. For example, treatment agency workers can readily print off the Personal Stories for their clients. The members of our community are very excited about the prospect of their writings helping people with substance use problems, and facilitating the education of practitioners working in the field.

Please note that these Blogs will move to our new web community site (www.wiredin.org.uk) when it is developed over the summer. We’ll be encouraging other people to engage in a wider community, via a personal web page we will provide that operates within our new content management system. Exciting stuff!

Another lovely day in Perth, sunny and 20 degrees. I lunched with an old school mate Clyde Bevan, who not only runs one of West Australia’s best eating places but is also Chair of the State Lottery Commission. You can guess what we talked about for some of the time – substance use problems in the UK and WA.

Reaching Out to Those People Who Wish to Support the Recovery Movement

2008-07-01T15:54:00.003+01:00

It’s a beautiful winter day outside, without a cloud in the sky, and I want to head off into Perth to enjoy the day and meet up with a close school friend. However, I just wanted to prepare something for the Blog I’ve been meaning to say for a little while now.

When Lucie, Kevin and I were in the North West of England two weeks ago, someone described to a colleague that Wired In was leading a new Recovery Movement in the UK. I pointed out to them that this was not strictly the case.

Wired In is facilitating the growth of a new Recovery Movement in the UK (and beyond), a movement that has no leader or national headquarters. We are helping individuals and organisations who support recovery and recovery advocacy to recognise the existence of each other and come together as a collective ‘we’.

This Recovery Movement aims to facilitate the development of a culture of recovery in the drug and alcohol addictions field. This culture of recovery will facilitate the efforts of individuals and families to overcome problems caused by substance use. It will also improve the way that organisations, communities and the nation as a whole help people find their personal path to recovery from addiction.

In facilitating the growth of a new Recovery Movement, it is important to learn from others who have undertaken a similar journey. William L White and colleagues have developed a New Recovery Movement in America. The history of this Movement, key underlying principals, and many other facets, are described in the seminal writings of Bill White.

There is little point in the UK drug and alcohol field reinventing the wheel when we have such excellent guidance as a starting point. Of course, we will end up taking different journeys in developing the recovery culture due to cultural differences between the UK and America. In the years to come, it will be interesting to compare the historical development of the recovery in both countries.

At this stage of our development, Wired In is trying to reach out and bring together people in recovery, and organisations and individuals who are helping people find recovery, in order to facilitate growth of the Recovery Movement. Therefore, please pass on details of our Blogs to anyone who you feel might be interested.

Wired In is also passing on the message that there are a multitude of different pathways that people have used to find their recovery from addiction. We want to provide hope to those affected by serious substance use problems, and show the diversity of recovery solutions, by providing living role models. We are therefore looking for people who are recovering or are in recovery, to write about their experiences and views so that they can be published on our website and/or Blogs. If you would like to do this, or discuss the matter, please contact us at lucie@wiredin.org.uk.

Now, it is time for me to head out into the sun and remind myself of the beauty of the city of Perth. This weekend I head up to Broome in the North West of Australia to catch the sun for 10 days. And a much needed rest.

PS. Have gotten back 'home' from the city since writing this and it really was a lovely day.

Government needs to provide genuine support for families

2008-06-30T14:30:00.002+01:00

I’m sitting here on the other side of the world (on holiday) looking through articles in Drink and Drugs News. I have read the excellent article by David Gilliver, entitled “Family Matters’, with mixed feelings.

I’m really pleased that David has written this article and highlighted the needs of family members of people with substance use problems. At the same time, I am saddened and very concerned by the fact that David has had to write an article on the same issue (i.e. lack of funding and support for families) that I focused on in ‘Family Misfortune’ over three and a half years ago in DDN.

The header to my article included the statement, ‘Far too little attention and support is given to the families and carers of people with a substance misuse problem.’ David’s header included the statement, ‘Many services are ignoring the fact that family members need support too’. In my opinion, the UK treatment system has not moved on much in helping family members during the three and a half year intervening period between the articles (please write in if you feel I am wrong).

True, there have been fantastic efforts by individuals around the country, which has resulted in the setting up of new family support groups and help to people who would not have otherwise received help. But this help has generally been achieved without a full commitment from the treatment system.

True, there is a commitment in the new drugs strategy to helping family members. However, what else could the government do - and let’s see a strong financial commitment before we get excited about this. Moreover, where is the commitment to the family members affected by a loved one’s alcohol misuse?

I first talked to Christine McEvoy of the Leicester-based family-based service Snowdrop about four years ago (gosh, was it really that long ago!?) and I really admired her determination to help family members. I am really pleased to see that she is still working in the field, but saddened to hear that she is still struggling to get support.

When we know that on average a person with a substance use problem negatively impacts on at least four other family members and loved ones, it seems so obvious that the system should be providing more support to family members to deal with their problems that have been caused indirectly by a loved one’s substance use. We at Wired In became very frustrated over a period of a number of years because we could not attract funding to support an initiative focused on developing and maintaining a web community for family members, an environment that would help many people understand their problems and help them along the path to overcoming them. What we wanted to do was so obviously needed – and obviously would be of great benefit. Our failure to gain support really annoyed me at times.

I’d like to pick up on two quotes in David’s article. Firstly, one from Christine McEvoy: ‘I’ve had meetings with the NTA and DAATs and it still feels as though people aren’t listening, or not acting on it if they are. I’d love to go and meet the government face to face in their cosy offices. They’re always banging the drum about how important families are and the holistic approach, yet there’s so little family support – let them put their money where their mouth is.’ I also challenge the NTA to put their money where their mouth is, and put it in a place where it is going to achieve the greatest effectiveness. The NTA will obviously have money for this agenda given what has been said in the new drugs strategy – please use it wisely and keep the funding coming over time. Don’t just provide a piece a tokenism.

Secondly, a quote from Vivienne Evans, CEO of Adfam, who has worked tirelessly in pushing the family agenda for a number of years: ‘Obviously it would be great if there was a specialist support service for carers and family members in every locality. If I’m being realistic, that’s not going to happen,…’

Now, I’m not sure what Vivienne means precisely by a ‘locality’, but the latter part of her statement can be construed in a negative manner. It sounds as if Viv feels that we are not going to realistically get what we should have. The trouble with this attitude, and the low expectations it conveys – isn’t it sad that we have been beaten down to having such low expectations - is that the government is going to be less likely to give what is urgently needed

So, let me say strongly and clearly, ‘The government(s) needs to commit itself to providing substantial funding for specialist support service for carers and family members to be developed around the country. These need to be connected by an information infrastructure that facilitates the work of individual organisations and helps them contribute more effectively to the greater whole.’

I’m not going to get bogged down in the nitty-grittys of this statement here, but I would be more than happy talking to senior members of government if they were willing to sit down and have serious discussions followed by the delivery of serious support.

'Our Community'

2008-06-29T19:37:00.003+01:00

Recently the Wired In team have been working very closely with the volunteers in our Recovery Community. Together we have created a series of blogs where the volunteers are sharing information about themselves, and their views and experiences of addiction and recovery.

When we initially set up the Our Community blogspot, we were not prepared for the enthusiasm shown by the volunteers. They have all excelled themselves in rising to a new challenge. Today we are launching their online community pages, and we hope that others will learn from their experiences and gain hope that recovery from addiction is possible.

Please take some time to look around the Community pages. Our Community blogspot is a work in progress. We will be continuously updating new information and encouraging new volunteers to come on board to share their experiences. This is an exciting time for the Wired In volunteers, who are so eager to help educate the field and help people who are affected by addiction.

Today we are also launching the next episode from our ‘Life as a heroin addict’ filmed series. This looks at the stigma around the drug scene and the drug addict and also the effect that stigma has on the drug user, including low self-esteem and paranoia.

The Future Redefinition of Treatment

2008-06-26T15:26:00.003+01:00

‘During the past 150 years, “treatment” in the addictions field has been viewed as something that occurs inside an institution – a medical, psychological, and spiritual sanctuary isolated from the community at large. In the future, this locus will be moved from the institution to the community itself. Treatment will be viewed as something that happens in indigenous networks of recovering people that exist within the broader community. The shift will be from the emotional and cognitive processes of the client to the client’s relationships in a social environment. With this shift will come an expansion of the role of clinician to encompass skills in community organization. Such a transition does not deny the importance of the reconstruction of personal identity and other cognitive and emotional processes – or of the physical processes of healing – in addiction recovery. But it does recognize that such processes unfold within a social ecosystem and that this ecosystem, as much as the risk and resiliency factors in the individual, tips the scales towards recovery or continued self-destruction.

As these new community organizers extend their activities beyond the boundaries of traditional inpatient and outpatient treatment, they will need to be careful that they do not undermine the natural indigenous systems of support that exist in the community. The worst scenario would be that we would move into the lives of communities and – rather than help nurture the growth of indigenous supports – replace these natural, reciprocal relationships with ones that are professionalized, hierarchical and commercialized.’

William L White in ‘Slaying the Dragon: The History of Addiction Treatment and Recovery in America’ (1998), pp 341.

Changing the focus of the treatment system: helping it achieve much more success

2008-06-25T17:33:00.005+01:00

Last week, I had a long phone conversation with Bill White, a major player in the Recovery Movement in America, updating him on what is happening in the UK as he is very interested. He also talked about some of the things that had happened on his side of the big pond.

Here are some of his thoughts in our discussion.

Government-led treatment systems tend to be based on a social cost model. This model focuses on manipulating and controlling people who are addicted to drugs, toward the aim of reducing crime, threats to public safety, medical care costs and other community-born costs of addiction.

However, a quite different organising framework is to organise the treatment system with a primary focus on personal and family recovery. That focus generates long-term reductions in social costs, but it does so as a side-effect, rather than a substitute for recovery. The recovery approach empowers and transforms people with substance use problems from community deficits to community resources.

The focus should move beyond what people are not doing (e.g. committing crime) to what recovering individuals and their families are adding to the life of communities. Control is about pathology reduction; recovery is about the addition and multiplication of assets.

Think about where the treatment system in the UK is today, and where it needs to go! And join us in that journey to place recovery to the fore in the treatment system.

Who is the client?

2008-06-24T15:41:00.001+01:00

‘Each era of addiction treatment opens with a vision of addicts voluntarily entering treatment and closes when such treatment results almost exclusively from coercion. The “client” whom treatment institutions serve cyclically vacillates between the individual addict and community social and economic institutions. Addiction treatment swings back and forth between a technology of personal transformation and a technology of coercion. When the latter dominates, counselors become, not helpers, but behavioral police. The fact that today’s treatment institutions often serve more than one master has created the ethical dilemma of “double agentry,” wherein treatment staff profess allegiance to the interests of the individual client, while those very interests may be compromised by the interests of other parties to whom the institution has pledged its loyalty.’

William L White in ‘Slaying the Dragon: The History of Addiction Treatment and Recovery in America’ (1998), pp 335.

On Blaming

2008-06-23T21:59:00.001+01:00

‘Harold Hughes, the political Godfather of the modern alcoholism treatment system, often noted that alcoholism was the only disorder in which the patient was blamed when treatment failed. Alcoholics and other addicts have suffered, not only as a result of poorly developed and at times harmful treatment technology, but also through being blamed for their failure to respond to such technology. For decades many addicts have been subjected to treatment interventions that had almost no likelihood of success; And when that success has indeed failed to materialize, the source of that failure has been attributed, not to the intervention, but to the addicts’ recalcitrance and lack of motivation. The issue is, not just that such mismatches do not work, but that such mismatches generate their own iatrogenic effects via increased client passivity, helplessness, hopelessness and dependence. Blaming protects the service provider and the service institution at the expense of the addicted client and his or her family. Defining failure at the personal level can also mask broader failures of social policy.’

William L White in ‘Slaying the Dragon: The History of Addiction Treatment and Recovery in America’ (1998), pp 331.

Historical tendency to oversell what treatment can achieve

2008-06-22T20:07:00.005+01:00

‘There has always been a propensity to oversell what treatment could achieve, both personally and socially. While such promises can help generate funding, they can create unrealistically high expectations of what treatment should achieve on a broad scale.

Jim Baumohl, in his review of the inebriate-asylum era, pointed out the danger of suggesting addiction treatment as a panacea for the cure of complex social problems. The overselling of the ways in which addiction treatment could benefit the home, the workplace, the school, the criminal justice system, and the broader community during the 1970s and 1980s sparked a subsequent backlash. When time - the ultimate leveller – began to expose the fact that these benefits were not forthcoming at the level promised, a rising pessimism fueled the shift toward increased criminalization of addiction. This recent history has underscored an enduring lesson: successful short-term strategies for generating public support for the funding of addiction treatment can have unanticipated and harmful long-term consequences.’

William L White in ‘Slaying the Dragon: The History of Addiction Treatment and Recovery in America’ (1998), pp 338.

In highlighting this quote on my Blog, I am not questioning the value of treatment. However, I am providing a word of caution to those who are trying to tell 'society' that the government-led treatment system is successful and is a panacea to some of society's problems. Those people trying to protect the NTA could ultimately contribute to a massive cutback in government funding for treatment when the true situation is realised by 'those on high'.

We must prevent this situation occurring. What we need to do is look at our current treatment system, accept the faults, and modify the system so it has a better chance of being successful. Put aside the pride, the arrogance, the fear of being accused of 'being wrong'. There is good in the treatment system and we need to utilise this good and the financial commitment of the government - developing a system based on people finding their path to recovery.

I go on holiday to Perth in Australia on Tuesday (leaving home tomorrow). However, I hope to maintain the Blog for part of the time I am away, whilst the team intend putting up some material for a period while I am sunning myself on a beach (I hope!) in the North West. Please bear with us if there are any delays in putting up new Blogs or Comments.

My apologies that I have not sent out a 'newsletter' before I go, to all those who are working with us or who have signed up to the Recovery Movement. It's been a bit frantic recently, but we will be in touch shortly. Lots of things are happening!

PS. New film on our YouTube channel focuses on the issues that can arise when a heroin addict tries to change behaviour - including what helps and what hinders this process.

Meeting a growing recovery community in the North-West of England

2008-06-19T21:13:00.010+01:00

Had a great trip to the North West of England earlier this week. Lucie, Kevin and I went to Manchester on Sunday, where we met Geoff Allman, Director of Spoken Image, a communications design company with whom we collaborate. Geoff was kind enough to drive us around for the two days, which gave him the opportunity to see some things happening in the field.

We spent the day with Jacquie Johnston-Lynch at SHARP Liverpool, which is described as a ‘therapeutic peaceful haven for addiction recovery’. SHARP offers a structured day treatment programme, based on the 12-step abstinence-based approach. We met Mark Gilman of the NTA, a man committed to the development of a recovery culture. Also met Peter Naylor of the Spider Project, that provides a range of services for current and recovering substance users, including creative writing, art, drama and outward bound events.

We talked with the SHARP clients in a group session and Kevin and I were both greatly moved by the occasion (I had tears in my eyes). The session emphasised to me the power of the supportive community or social network. I just felt the empathy and positive feeling throughout the room.

In the evening, we met with a group in a Manchester café – Mark Gilman, Stuart Honor (researcher and recovery advocate), John Hopkins (ADAS/Acorn in Stockport), Colin Wiseley (Commissioner, Salford DAT) and Ian Wardle (Lifeline Project). I had one of those moments when you meet someone whom you immediately recognise as a kindred spirit – in this case, the beaming giant Stuart Honor.

Two lads were sitting across from us on another table. Amazingly, they first recognised me from DDN and then Kevin from his film – and then Stuart, an old mate. We couldn’t believe that the world was so small and this wonderful coincidence has expanded our community into Blackburn – Paul (Hutchins) and Jason are working at the Thomas Project. Stuart was pleased to see them doing so well in their recovery.

We had a good dinner – thanks Ian - and I can tell you, Mark Gilman is a scream. You’ve got a role in one of our films, Mark.

The next day we went to Warrington to visit Tom Kirkwood, Director of Trust the Process, an organisation that provides a structured day care programme and community support. Spent a few hours discussing the field and strategising with Tom and Danny, a senior member of the team.

I was impressed by Tom’s insights and he talked to us frankly about his personal recovery. He is a businessman who is determined to set up a number of recovery-based centres around the country. He took us to the houses his organization provides for some of the clients. We were impressed – and they were new!

We also met two members of the Warrington DAT who were kind enough to come over and meet us. Amanda Finch emphasised to me how great it was to go into a room of happy-faced clients at Trust the Process. That’s what we want to see!

Back to Manchester for a Chinese Buffet (yummee!) and the long train trip back to Cardiff. I was pretty tired by the time I got home (21.15) and started to write this Blog after the football. However, I was Skyped at 23.15 – by Kevin. He was absolutely ‘buzzing’. He pointed out to me that we wanted to develop a recovery community here in Cardiff. There was an expression on his face I had not seen before – a sort of serenity.

It’s great fun talking to and working with people in recovery. I’m a proud man being in this field.

Check out the piccies.

You are wrong Mr Hayes: the treatment system is NOT working!

2008-06-18T11:12:00.006+01:00

For the last few years, I've thought a lot about how to change the treatment system so that helps more people overcome addiction and gain a better life. At one stage, I had come to the conclusion that I needed to work with the people at the top, to help them understand the shortcomings of the current treatment system and see how it could be changed.

I gave a talk at the FDAP Annual meeting last year where I described the shortcomings of the system and emphasised that unless we did something we would end up like the American treatment system in the late 1980s and early 1990s - money was slashed and the system collapsed. I also pointed out the way we needed to move forward, which I have reiterated in the Wired In 'Way Forward'.

I had a very positive response to my talk from a senior person within the NTA and I thought that I could enter into some long-term dialogue with the NTA that would lead to positive change. A change to a treatment system that is based on people attaining recovery - and I mean a genuine recovery, not some politicised excuse of recovery - is inevitable sooner or later. I thought that I could help speed up the process.

Well, after seeing the Paul Hayes article in the Guardian today, I realise how naive I have been. I'm not going to go into any great detail about the article, but I have to confess that it has made me angry. I quote, 'Hayes dismisses his critics as a few academics, politicians and "ideologues" stocked up by the media'. This is absolute rubbish - Paul Hayes either has his head very deeply buried in the sand or he is deliberately being untruthful.

There are many, many thousands of people out there who know that the current treatment system is NOT working and is causing damage to many people. These people who know the truth come from many different aspects of life - they are users, ex-users, family members, practitioners, commissioners, members of the general public, etc.

I've been in the North West for the past couple of days and it was quite clear to me that the people I spoke to all knew many people who know the system is not working and are tired of the NTA spin. Even some commissioners who do not really care about people with substance use problems realise that the way methadone is being used in many treatment programmes is not reducing crime and is storing up problems for the future.

Anyone can use words to create a false story, mislead people by playing with facts, and distract them by creating false concerns. Sooner or later such people are found out for what they are doing. It is time that Paul Hayes is found out for what he is doing. I encourage those people who do not believe that the current treatment system is working to write to Gordon Brown and tell him. Write and complain that Paul Hayes is misleading the country about what is truly happening.

We are talking about people's lives here. They are far more important than defending the current treatment system. Mr Hayes may think that few people will stand up and be counted - and maybe initially this will be the case. But there is a gathering momentum in the country for a treatment system that is focused on improving people's lives - rather than giving them a pill to keep them quiet - with an increasing number of people getting fed up with Mr Hayes's spin. The day of reckoning will come.

People with substance use problems need opportunity, choice and hope. The UK treatment system is not providing these key elements.

I leave you with a quote from Stuart Honor,

'It is no great trick to take an impoverished, unemployed individual who is addicted to heroin (and crack?) and turn him (sic) into an impoverished, unemployed individual who is addicted to heroin, crack, methadone and/or alcohol and benzodiazepines.'

Personal Story of Chris Hobbs

2008-06-15T07:27:00.003+01:00

Chris Hobbs is a member of our Cardiff community of volunteers, who I first met when he came out with us to lunch with Pavel Nepustil, visiting from the Czech Republic.

I remember Chris really struggling to keep awake with the dose of methadone he was being given. As he points out in his Personal Story, he tried to explain to his keyworker that he wanted a lower dose because he was forever falling asleep at home. This was frustrating, since he had a new baby to be looked after, and he felt like his partner was having to look after two of them. His keyworker did not seem sympathetic and was more concerned that Chris would relapse if his dose was reduced.

The words of Kevin Manley come through here – his film is on our YouTube Blog – he emphasised the number of practitioners who just wanted him on methadone, and did not appear to be concerned with his real needs. All practitioners need to understand what treatment is about. I quote from the excellent book, ‘Treating Drinkers & Drug Users in the Community’ by Daphne Rumball and the late Tom Waller:

‘Treatment decision-making that is likely to be most successful is based on decisions made by the service user.’

‘Therapeutic help does not imply that the therapeutic helper takes over and sorts the problem out. Drinkers and drug users must do this themselves, for this not only increases the chance of a successful outcome, it also helps raise self-esteem, and the empowerment of the individual raises personal belief in his or her ability to overcome dependence (self-efficacy).

Other people, however skilled they may be, never make a drinker of drug user better. It is always the client who does the work. Helping professionals can make assessments, point the way, offer suggestions, provide interventions tailored to meet a client’s needs, give appropriate counselling, and do what they can to improve the client’s environment, but success, when it comes, always belongs to the client, never to the professional worker.’

Please spend some time reading Chris’s Personal Story. We’ve also put up some new film on our YouTube channel, which you can access from the ‘Our Films’ Blog. We look at the physical effects of heroin addiction, including the risks and effects of blood borne viruses.

I’m off to see some treatment agencies in Liverpool and Warrington, and savour some of the recovery atmosphere that has been generated in the North West of England. I’ll try to Blog whilst away, but please bear with me if there are any problems.

PS. Awesome Bruce Springsteen & The E Street Band concert at the Millenium Stadium in Cardiff last night! A true icon of rock music!!

A Great Book and a Great Rock Star

2008-06-14T13:17:00.004+01:00

Just got back from the gym to find a book I've been waiting for on the doorstep, having finally arrived from the States. I have read 'Slaying the Dragon: The History of Addiction Treatment and Recovery in America" by William L White before. A copy had been loaned to me by Tim Leighton who just said, 'This is one of the most remarkable books you will read.' And he was right!

I now have my own copy, so I can mark key passages in the text, as I love to do. It is the sort of book you pick up at any time, just to read a small passage. The book takes you on an amazing journey through the history of addiction treatment and recovery in America. I am a great believer that you can learn a lot from the past.

This book is essential reading for everyone working in this field. And yet, I have met only two people in the UK who have read it! You must purchase this book!!

I've got to charge now, because I am the lucky holder of a ticket to see the Boss, Bruce Springsteen, and the E-Street Band tonight. The gig is at the Millenium Stadium in Cardiff, which as far as I am aware, is the largest indoor stadium in the world when the roof is closed. It's going to be awesome!!

I leave you with a quote from Bill White's book:

'What we are professionally responsible for is creating a milieu of opportunity, choice and hope. What happens with that opportunity is up to the addict and his or her god. We can own neither the addiction nor the recovery, only the clarity of the presented choice, the best clinical technology we can muster, and our faith in the potential for human rebirth.'

Wired In to Scotland

2008-06-12T22:15:00.002+01:00

Lucie and Kevin have just got back from two exciting days in Scotland. They spent the first day in the LEAP project, led by Dr. David McCartney, in Edinburgh. As I write this, I’ve just had two emails arrive, one from Kevin himself. So I should let him describe what he thought about his visit. Please come back here after reading Kevin's Blog.

Lucie could not get over the energy that she felt in LEAP. The welcoming atmosphere was special, although clients thought that Kev and Lucie were there for their first session. Lots of people came up, and were positive and open about what they would receive at LEAP. Lucie could not get over the fact that LEAP offered a two-year aftercare programme. Now, this is a serious recovery-orientated programme, as far as we can see. They have what seems to matter, positive community spirit. Can’t wait to work with them!

Lucie and Kev moved on to Glasgow for the ‘Drugs and Alcohol Today’ conference. They were armed with lots of pieces of paper (e.g. Personal Stories, Wired In ‘Way Forward’ document), DVDs and a Mac to show the films and Blogs.

Lucie was thrilled with the response that they had at the meeting. Substance use workers really wanted to get involved with what we are doing, and wanted to be able to get their clients involved. A number of workers, as well as service users, signed up to the Wired In Recovery Movement.

Lucie pointed out that lots of people were talking about recovery, sorry Recovery. They were excited!

Lucie also met 'tim1leg', our new close collaborator from the West coast of Scotland. She described Annemarie as a ‘bundle of passion’. You’re on board Tim, whether it is on one or three legs!!

Finally, I must get you to visit the latest Blog from our good Czech Republic friend in Texas, Pavel Nepustil. As an aside, Pavel, how do you think your football team is playing? We’ll allow you a Blog comment on football, good friend!

Risk and Substance Use: The Impact of Drug Laws

2008-06-10T23:02:00.004+01:00

In yesterday’s Blog I wrote, ‘We are calling for a society that does not stigmatise people with substance use problems’.

In response, Derek Williams wrote, ‘I agree that needs to be a first step, but it simply isn't possible when the very basis of the drugs policy is prohibition which treats the casualty as a criminal. You're getting very close to calling for a review of our prohibition based approach, I hope you can go that extra mile and do so.’

I don’t get drawn into such arguments, Derek. There are plenty of people in the UK fighting hard for this policy. I want to devote my energies and time to fighting the case for improving access to recovery for people affected by substance use problems.

I will say the following though. By making a drug illegal, society increases the risks for a person using such a drug. Whilst applying technology to reduce the risks of using legal substances, society often withdraws technology to increase risks from use of prohibited drugs.

“We prohibit a “bad” drug on the rationale that it is dangerous, and then construct social policies that assure high risks related to the drug’s use.” William L White, ‘Pathways from the Culture of Addiction to the Culture of Recovery’

Let’s compare legal and illegal drugs. The legal drug could be highly addictive, such as a benzodiazepine.

With legal substances, we reduce risks by ensuring that substances are not contaminated, adulterated or misrepresented. This is rarely done for prohibited substances, greatly increasing the risks associated with their use.

With legal substances, we reduce risks by packaging the substance in ‘doses’ that provide predictable and desirable effects. The person using a prohibited substance rarely knows the purity of the substance purchased – this is determined by the actions of illicit suppliers, when they cut the product – and therefore the dose they are taking. This increases risks when using, with potential overdose sometimes being a reality on a day-to-day basis.

With legal substances, we screen out and discourage use by those people who might be susceptible to the detrimental effects of a particular substance. The packaged drug carries a message saying that it should not be used if a person has such-and such a problem, or if the person is using another particular substance. The person using a prohibited drug does not generally get this form of information, thereby increasing the risks they are likely to face.

Legal substances are administered into the body in a way that is designed to reduce untoward consequences, such as the spread of disease. Injecting drug users can contribute to the spread of blood-borne viruses such as HIV and hepatitis C by sharing needles, syringes and other injecting paraphernalia. Therefore, users in the UK are given access to clean injecting equipment – e.g. via treatment agencies, some pharmacies - to reduce the likelihood of blood-borne viruses being spread.

However, this harm reduction practice does not occur in other parts of the world, including a number of states in America. It is argued by some people that provision of clean needles and syringes encourages drug use. In essence, technology is being withheld in order to keep the risk of prohibited drug use high, in the hope it will deter use. This is morally wrong. The price of this approach is that people contract disease and die not because of the drug, but because of the social policy that prevents society from reducing risks associated with its use.

Harm reduction and harm minimisation techniques can be applied to the other points raised above, and in this country are applied to at least some extent. For example, warnings are put out if a particularly high purity sample of heroin is identified to be available on the street. At the same time, however, it is argued that if prohibited drugs were made legal, then issues of purity, adulterants, etc would become a thing of the past, because people would purchase heroin from a government-controlled source.

There is another major way that legal status affects the substance-using culture and the way that people behave and think. When a drug is classified as illegal or prohibited, a powerful social stigma develops that impacts on the emotions and behaviour of people who use the substance. This arises because of the attitudes of society towards users of prohibited drugs – drug users become stigmatised, stereotyped and prejudiced against. You can see an example of this prejudice in research that we have conducted.

Now at the end of this you may turn around and say, “Certain drugs are illegal, so people should not use them. The risks they face are at their own peril.’ On the other hand, you might be wondering why certain psychoactive drugs have been made illegal and whether the actions of the state are justified. Check out some of my early Background Briefings from Drink and Drugs News, which you can find on a related Blog.

[This Blog was inspired by a section in William L White’s book, ‘Pathways from the Culture of Addiction to the Culture of Recovery’]

New Film on our YouTube Recovery Channel

2008-06-09T21:55:00.002+01:00

It's been a bit of a busy day, and along with a severe dose of hay fever (which slows one down) and a visit to the vet with my beloved aged Welsh collie Tessa, I've run out of time to write a full Blog.

However, I can tell you that Lucie and Kevin have loaded up on some more film on our YouTube channel which you can link to from the Our Films Blog. This section focuses on life as a heroin addict, with the same people who were introduced last week.

If you want to check out all our film material on YouTube, check out the Wired In Recovery channel, to which you can subscribe. Please send the details to as many people you can.

I can tell you that the people who participated in these film clips are really excited to know that they are being looked at by lots of people.

Just had a talk with Lucie from Glasgow where she and Kevin are attending a conference tomorrow. They spent the day at the LEAP project (led by Dr. David McCartney) in Edinburgh and had the most amazing time. They were absolutely buzzing about what they saw and the potential for a strong collaboration.

Going to have to tell you more about LEAP in a future Blog. What I can say is that it's one hell of a recovery project (excuse the swearing) and is making a significant impact. I tell you what - it's a good job I live within 15 minutes of Cardiff airport and Kevin and Lucie live only a few minutes further away. We're going to be using the shut-eye express (07.00 flight) between the two Celtic nations quite a bit! And I love Edinburgh!

Voices

2008-06-08T22:53:00.006+01:00

Addiction

The Recovery Agenda is Underway - Embrace it

2008-06-08T20:05:00.008+01:00

In the middle of May, I launched the Wired In 'Way Forward' on this Blog, a document showing the commitment that my colleagues and I are willing to make to help improve the way this country (and others) helps people overcome substance use problems. We outlined some of the serious shortcomings of the government-led treatment system in the UK, and described major changes in approach that this country needs to adopt.

Quite simply, we need a revolution in this field in the UK. We need to stop playing political games, cut out the 'spin', and get on with genuinely trying to help people. We need to stop defending the status quo and attacking the people who speak out, saying that they are 'threatening' the current treatment system and hurting the field.

It would help greatly if we started to think about helping the individuals who are directly affected by substance use problems, as well as their families, rather than talking about protecting society from the crime that a small proportion of people with a substance use problem commit. Many people with serious substance use problems have other serious life problems (e.g. poor mental health, victims of abuse, social problems), which are often present before drug use is initiated. Many are very vulnerable - I often feel embarrassed how my country chooses to pick on these vulnerable people and accuse them of causing problems in society.

We also offer them a deeply flawed treatment system, one which offers little hope of recovery - and we then blame then when they don't overcome their problem.

There are many people 'out there' who feel the same as me, ranging from senior figures in the field to individuals and families who are impacted upon by substance use problems. Many people working in the field do not feel they can speak out because they feel their job may come under threat, or the organisation they work for may be criticised. Many people affected by substance use problems don't speak out, because they don't how, and/or to whom.

Well, it's time for all this to change. And it will change!

Wired In is calling for a treatment system that helps people find recovery from serious substance use. We are calling for a society that does not stigmatise people with substance use problems and their families. We are calling for a government that shows an understanding of what is required and does something about it. We are asking for compassion and the provision of hope, opportunity and choice.

I was recently informed that the government will spend £800 million this year on treatment. Please think how much of this money has been well spent? Ask yourself whether we have a system that actually understands how to help people move from the culture of addiction to the culture of recovery? Is it capable of doing this? And how much does it care?

Have a look at our 'Way Forward' and ask yourself whether I am right in the criticisms I have made about the current treatment system.

If you want to see change, then please contact us. Wired In is committed to helping achieve this change - with your help. I cannot promise we will succeed, particularly as our funding has almost run out. [My personal investment has come to an end, so I need to raise funding to push the agenda forward]. But we are determined to succeed, so don't underestimate us.

And don't underestimate what is happening in this country. The recovery agenda is underway - embrace it and become part of the Movement. Join others who have already joined up with us.

Pace Yourself: It's a Marathon

2008-06-05T18:02:00.004+01:00

Decided to take a slow day to try and throw off this tiredness, thinking maybe I'd been pushing too hard. Mustn't forget what I'd read in one of Bill White's books:

'Pace Yourself: It's a Marathon'

'One must be careful in carrying light to the community to not leave one's own house in darkness.'

All of you working in the field must remember this. I know that some of you put your hard and soul into your work and helping the client - and neglect yourself too much.

For those people who are trying to change the environment and the treatment system in this country, remember it will be a marathon. Pace yourself. But we'll do it.

I've just finished a 45 minute discussion with Bill White - my first ever - and it was inspiring. One of the things that excited me is that Bill is inspired by what is happening here. Inspiring an inspiration, now that is something!

Rowdy Yates from Scotland called to say he was enjoying the Blog. He also pointed out that there is something in the air re: recovery. He had noticed an increase in activity in substance use internet discussion groups starting about six months ago. More people are asking more questions.

I just want to finish with something I read this morning in a talk sent to me by Stuart Honor. As cynical as I am about the way that much of the treatment system is helping people overcome substance use problems, it still hit me hard. I'm going to come back to this in a later Blog:

Adapted from Elliott Currie (1998) 'Reckoning: Drugs, the Cities, and the American Future'

I'm so chuffed

2008-06-04T20:34:00.005+01:00

This is going to be a short (well, sort of) Blog, but for you out there who are watching closely at what is happening - let me say, it's getting very interesting.

I've had assurances in past two days that people are reading my Blogs and taking serious note. It has also been emphasised to me that my Background Briefings are impacting, seriously. And some people are going on to discover Bill White and his writings. I'm so chuffed.

I'm getting calls and e-mails from new people. The viral marketing process is starting.

The people who are contacting me are disillusioned with the system as it is - and they know many others who feel the same. Anyone can moan though. However, the people who are contacting me are doing something about it. Their problem is that they have felt isolated in what they are doing.

Hopefully, they are seeing that they do not need to be isolated.

If Wired In could bring such people together and create a 'Voice' - then it wouldn't just me that would be WOW-ed.

Karen, you should be so proud of what you have achieved in recovery. You are, and will be, an example to so many. Cannot wait to see your e-mail and to meet you. Lucie is very excited as well!

Stuart, I LOVE good research, just send it all in!!

David L, thank you for your kind words.

Tim1leg, keep writing.

And the rest of you, you must read the comments on yesterday's Blog about Mark Gilman.

I leave you with a quote from an e-mail I received today: "These are exciting times David and i finally feel that the momentum is moving towards more dynamic working which makes the individual the stakeholder. The indigenous recovery community will undoubtedly offer a kinship that no service will touch."

Gosh, it’s been a funny old day

2008-06-03T18:47:00.005+01:00

Felt really burnt out this morning. Dazed when I woke up, and never really got going. But lots happened during the day.

Probably a combination of a number of factors have contributed to my mental and physical state: recovering from being a single dad with three kiddies for a week; too much work to catch up with; long-term worrying about funding; having to face a couple of days doing admin (which I hate) and probably some dehydration. Potent mix!

Soon stopped feeling sorry for myself when I read ‘In The Flesh’ from the Druglink Blog, which portrayed a day in the life of a treatment agency worker. You must read this well-written article. It reminded me yet again how tough it is in the front lines of this field. And how divorced the ‘top’ is from the ‘bottom’. More of that in a later Blog, when I return to the issue of stigmatisation.

The article charged me up and made me feel good about what I am trying to do. At the same time, it made me reflect on the size of the mountain we’re trying to climb.

After an admin session, I had a good chat with Mike Ashton, a fellow information junkie. I thoroughly enjoy my chats with Mike as he is so knowledgeable. I love bashing issues through with him – he is very perceptive and his heart is in the right place (something which I have found to be essential in this field if you’re going to relate to me).

I then had the most invigorating discussion with Mark Gilman of the NTA who described various recovery related projects in the North West of England. In fact, he really WOW-ed me and I now cannot wait to meet him in a couple of weeks time. Yesterday, Dr Dave McCartney in Edinburgh told me he thought there was definitely something in the air re: recovery. Today, it was further confirmed to me.

Finished on phone and, 'ping', an email from Lucie arrived - 'had a wicked morning catching up with volunteers', she said before describing events. Sounded fantastic, this small and growing group getting really excited about their Cardiff recovery community and future community pages.

Brian looked at the questions we had given him to facilitate his community page and thought about the five words 'that best describe you'. He started and ... wrote an 11 page personal story, which really touched Lucie with what he had been through. How could any decent person stigmatise Brian because he used heroin to help him deal with problems that would have broken the vast majority of people?

Just as I started writing this Blog, Shari Allwood from SMART Recovery in the States popped back into my life via e-mail. Shari and I met when I attended a SMART conference a couple of years ago but we had lost touch recently. Shari had seen the new Blog and just wanted to congratulate me – which meant a lot. And now Chris Ford has popped up to say thanks for the comments I made about her latest article in DDN – which again you must read. Her article made me stop and think again about stigma and prejudice.

You know, there’s some really great people out there doing some really wonderful work. We’ve got to shout loud about it, because it’s ultimately going to help more people overcome their problems. And it’s going to give recognition to those wonderful people who are making the difference. And help fight prejudice and stigmatisation.

For now though, I’m totally bushed (if this Blog is unclear, you know why) – but contented. I might treat myself to an Indian takeaway. I live on a farm, across the road from a high quality India restaurant – believe it or not. A few of you will know it as you’ve eaten there!

Wired In Reflections, Part 2

2008-06-02T18:17:00.004+01:00

At Wired In, we have drawn up a series of statements forming an underlying ‘philosophy’ that provides clarity and helps us steer our course of action in this field. We believe that the statements are not just important for Wired In, but for the field as a whole. We ask you to consider them and let us know what you think. I’m sure we’ve missed key points.

Wired In considers substance use problems and addiction as a heath/social issue (which they are), rather than a criminal justice issue as the current treatment system does.

Wired In focuses on ‘drug, the person and their social context’ rather than on the drug itself, as the current system does. Unless the implications of the former interaction on addiction and recovery are understood, we have no hope in tackling substance use problems.

We do not just focus on the physical aspects of addiction, but also on the culture of addiction and how it impacts on the individual. We cannot help people overcome serious substance use problems without understanding how to move people from the culture of addiction to the culture of recovery.

Wired In focuses on ‘behavioural change’ rather than the ‘drug’. There seems to be a lack of realisation amongst many in the field that the key to recovery from addiction involves understanding behavioural change, rather than telling people about drugs. People with substance use problems already know about drugs!

Substance use problems rarely occur in isolation, but are often one part of a much larger cluster of problems (containing, for example, emotional and/or social problems). This means that we must provide access to a range of integrated services that target a broader range of life functioning. To do this effectively, individuals in these other services need a better awareness and understanding of substance use, the associated problems, and how these can be overcome.

Since addiction is a chronic disorder caused and complicated by a variety of psychological, social and biological factors, we need to understand that treatment can be complex and protracted. The current system has been developed for an acute disorder – it needs changing to be able to tackle the chronic nature of addiction.

Wired In is concerned with a wide range of substance use problems arising from use of various illicit drugs (e.g. opiates, stimulants, sedatives, cannabis), prescription drugs and alcohol, rather than primarily focusing on Class A drugs (heroin, crack cocaine). Substance use problems occur on a continuum of severity. We are committed to providing information and support for people experiencing all levels of substance use problem, not just those with the most serious needs.

Wired In focuses on recovery, not on treatment – treatment is too often considered an end in its own right, whereas it is only one way of helping a person overcome their addiction. Recovery sustainability is rarely achieved in the short span of time that treatment agencies are involved in peoples’ lives.

We recognise that treatment is very important, particularly for people with serious problems and low recovery capital (internal and external resources that can be used to help find recovery). However, treatment must be part of wider programme of recovery support.

We believe that recovery comes from within the person, it should not be imposed on someone by a practitioner. The practitioner must understand that their role is to act as a guide and facilitator in helping a person utilise a self-change process. They must show warmth and empathy, and have a deep understanding of what it takes to help someone move from the culture of addiction to the culture of recovery.

We believe that people should be informed on an ongoing basis of the range of options that are available to help them overcome their problems (and be able to access these options), rather than just be offered a substitute prescribing option that can result in a switch from one addiction to another, as commonly occurs in the UK treatment system today. The system today can be viewed as containing the problem, rather than tackling the problem.

Wired In aims to empower people to tackle their own substance use problems and those of their loved ones. The average human being has a great deal of resilience and many people are capable of using their own resources if taught well and provided with the right sort of support (including empathy and understanding). This support may involve helping people deal with a variety of other life problems, to ‘free up’ their personal psychological processes so that they can focus on finding recovery.

To help people overcome substance use problems, Wired In uses key principles that are known to underlie successful therapeutic interventions, e.g. believe it can be done; information is key; enhance motivation; goal-setting; use support networks; learn relapse prevention; giving up substances must feel good.

We are committed to developing communities of recovery (internet- and real-world-based) that provide hope and opportunity, and enable people to help others find their path to recovery. These communities of recovery will carry a powerful voice of people who have been affected by substance use problems.

Commissioners and other people involved in developing policy about substance misuse treatment must have a deep understanding of what it takes to help someone move from the culture of addiction to the culture of recovery.

Wired In is committed to reducing prejudice and the stigmatisation of substance users, ex-users and families in society. A key element of recovery is the substance user being accepted as ‘normal’ by a so-called ‘normal society’.

Wired In Reflections, Part 1

2008-06-01T10:42:00.012+01:00

Having developed WIRED eight years ago – as a way of empowering people to tackle substance use problems - it was with a tinge of regret that we changed our name to ‘Wired In’ at the beginning of April. This change was considered a necessity, given the well-branded WIRED magazine in the States.

At the same time, we were very excited about our new identity and commitment to recovery. We have always believed that ‘wiring in’ people (both from within and beyond the field) was an integral part of our grassroots initiative. We incorporated the word ‘recovery’ into our logo, because we had not previously made explicit our organisation’s commitment to helping people understand and be able to find recovery.

We also believe that the field itself does not focus enough on recovery, and that the vast majority of practitioners do not really understand the concept. This is probably the single most important reason why the field is not being as successful as it could be in helping people overcome substance use problems.

In the past, we have emphasised the grassroots nature of WIRED and the importance of our ‘bottom-up’ approach to producing enduring success in tackling substance use problems. We have also emphasised the importance of empowering people to tackle substance use problems.

Each of these elements - the grassroots approach, empowerment, giving the people a voice, and helping other organisations achieve their aims – all help define what Wired In actually is and what it represents. But something was missing.

Since changing our identity, the final piece of the puzzle has clicked into place. It is the simple fact that we are a Recovery Movement. Our major underlying aim is to help people find their path to recovery.

Wired In aims to provide people affected by substance use problems with the information and tools they need to best help them overcome their problems using: (a) their own personal psychological resources; (b) the support and help of loved ones and friends; and (c) community-based treatment and support services.

We also aim to provide practitioners with education, training and information that facilitates their work in helping people find recovery. The voice of the people affected by substance use problems will form a key element of our approach.

So what is recovery? In my Background Briefings on recovery last year, I included a definition from William L White which we find particularly useful and pertinent.

Recovery is defined as, “the experience (a process and a sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD-related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life.”

One important point to emphasise here is that this focus on recovery is part of an important new trend in the US, a moving away from focusing on the problem (addiction) to focusing on the solution (recovery). There is a greater recognition of needing to look at how millions of people have found recovery, and developing principles and practices based on these lived solutions.

In starting and driving our Recovery Movement forward, we believe it essential that Wired In has a Charter, a set of ten values and principles that help define how we think and act (see www.wiredin.org.uk).

For example, Point 2 states, “Wired In is founded upon Trust: we are independent, objective and honest. Wired In is about being creative, and having the courage to challenge.”

We have also drawn up an underlying philosophy that provides clarity and helps steer the Wired In course of action in this field. A series of statements which reflect this philosophy will be presented tomorrow.

Today, check out the introduction to our new film material on YouTube, which is the first part of a series focusing on 'Life as a heroin addict'.

My 50th Posting: Kids and friends

2008-05-30T22:11:00.004+01:00

My three youngest - Ben (12), Sam (7) and Natasha (3) - have been staying the past week, which has meant a major change in lifestyle. One gets out of practice seeing youngsters only every other weekend, and half of the holidays, so it sometimes takes a little time re-adapting to being a single dad. But I love it.

I've been on the back-foot with my writing and other Wired In activities. In fact, they've been rightly relegated into the background. However, there has ben a lot going on so I've had to pick up the computer whenever I could.

I had a meeting with a film production researcher (and Lucie and Kevin) on Wednesday which was very interesting. Kids had to be relegated to another table - armed with computer, Gameboy, etc - where they enjoyed their own special lunch. Rachel went on to meet some of our volunteers and that sounded as if it well really well. Certainly fired up Kevin on his Blog.

One real pleasure this week has been a regular email correspondence with Bill White, one of the leading thinkers in this field. Made me realise what little short messages can do to one's enthusiasm, drive and mood. When you're working away with just a few people and no funding, trying to help make major, much-needed changes to a field, little short messages can mean a lot.

It's also been great communicating all week with a small core group of UK people trying to move the recovery agenda along. I'm discovering new friends, good people I know I'll be working alongside (mainly virtually) for a long time into the future. It feels good!

New Wired In Blogs

2008-05-28T19:58:00.003+01:00

I want to introduce you to two new Wired In Blogs. Firstly, 'What I've Heard' written by a collaborator of ours, Pavel Nepustil, from Brno in the Czech Republic. Pavel is currently in Houston on a Fullbright scholarship. He is a NGO social worker and PhD student, carrying out research with former methamphetamine users who gave up using without treatment.

'My Life' is written by one of our volunteers, David Wright from Newport. Some of you will remember David's story being told in Drink and Drugs News a couple of years ago. David starts with this story linking up to the original magazine articles. David is a prolific writer so keep an eye open for lots of future Blogs once he gets used to the system.

Meanwhile, Kevin's Blog goes from strength to strength - watch his latest 'Grease Medley' video on our YouTube channel. A real highlight today, not just for Kevin but for the whole team. A message from Bill White which said quite simply, 'Love Kevin's posts. Tell him to keep writing. We need his passion and his voice.' Kevin must be over the moon to receive such a compliment.

On isolation and recovery – an excellent article by Ian Wardle

2008-05-27T22:47:00.002+01:00

The past few months have been very interesting times for what I can only describe as an urgently needed recovery agenda in the UK.

Yesterday, we saw published online an erudite discussion on recovery and the UK treatment field by the CEO of Lifeline, Ian Wardle. He has written an excellent article, one which should be read by all people working in the treatment field, as well as by politicians and others who impact in one way or other on our efforts to help people overcome substance use problems.

I would love to devote a good deal of time discussing this article, but my three youngsters have come to stay for a week and have left me somewhat brain-dead. However, it would be wrong of me to say nothing about Ian’s article. So, ‘please keep quiet upstairs!’

I found Ian’s focus on the isolation of the treatment field and the implications of this isolation fascinating. In my opinion, there is no doubt that embedding drug treatment in the criminal justice system is greatly hurting our efforts to help people overcome substance use problems, as I will discuss in one my forthcoming Wired In Reflections.

The field is also hurting itself by getting bogged down in arguments about harm reduction vs. abstinence, as has been discussed in some of my other Blogs. As Ian points out, we are isolating ourselves from each other. This is unnecessary, as the recovery writings of Bill White and colleagues reveal.

Ian emphasises that we are becoming isolated from people outside this field. People from outside the field that I know (and trust) who are aware of what I am doing are horrified by some of the dogma they read in our field. They cannot believe that some people seem more interested in looking after the system than the clients.

Ian also points out that we are isolated from the new personalisation and recovery-orientated philosophies that are inspiring people in other sectors of health and social care. It has surprised me how many people in the drug field are so inward-looking – they don’t look to learn from other fields, which is naïve given the relatively new discipline in which we work.

I believe it was an excellent idea of Ian to focus on the isolation issue. It has certainly made me think about this issue more explicitly. There are a number of suggestions for the future way forward that are indicated by Ian’s article.

However, I felt that two messages may not have got come through strong enough – I apologise to Ian, if I have misread things. Firstly, there is a lot we can learn from the writings and actions of the US recovery movement. We don’t need to reinvent the wheel, but at the same time our recovery efforts in the UK will take us in some different directions.

Secondly, we must listen much more to people who are recovering or recovered from addiction – and learn from them. We generally do not do this well in the UK.

Thanks for a very thought-provoking article, Ian.

On two Celtic fronts (Scotland vs Wales)

2008-05-26T10:03:00.005+01:00

It's Bank Holiday here in the UK. Tomorrow will start a major week for the field in Scotland as they will be introducing a new strategy, one focused on helping people find recovery. I referred to, and complimented the Scottish Government for, the change occurring in Scotland in my Blog of March 28th, where I also linked to my Drink and Drugs News articles on recovery. If you really want to get your teeth into some good reading on recovery then turn to Bill White's page on the Faces and Voices of Recovery website.

I am looking forward to reading the new Scottish strategy and I really hope it leads to significant changes in approach, and to a massive increase in the number of people finding recovery. However, we must remember that here is a substantial difference between a written strategy on recovery and the implementation of all the changes required to make it work. There needs to be a significant change in ethos from top to bottom. Sadly, I feel sure there will be much lip service paid to the word 'recovery' (and much misconstruing of what it means) by those people who want to maintain the status quo. At the same time, I know some of the people who are totally committed to this approach - and they will work very hard to make sure that it bears many fruits. Change will not occur overnight, but it will change as long as those people supporting the recovery agenda are given the support they need to move it forward.

Meanwhile, here in Wales, nothing much changes! Dr Brian Gibbons, the minister in charge of the substance misuse agenda - he who does not respond to important emails - has been on a week of spin during the National Tackling Drugs Week. He tells us that there have been "massive strides forward" in tackling the drugs problem in Wales.

Utter poppycock! Unless you consider making adjustments to the English strategy, publishing a document, spending money, trying to attract people into 'treatment', and counting numbers of people going through the door, a significant advance. Anyone can do that! What is important is the provision of effective treatment that helps people overcome their problem (not just one or a few people that you trot out for the newspapers) and a system that allows practitioners to be able to do that. It also requires an understanding of what is required to help people, by those in charge of the system.

Those of us who know what really is going on in Wales know that Mr Gibbons and his team have little idea of what is required. I very rarely ever hear anyone pay a compliment about the Assembly' efforts to help people overcome substance use problems (except those people working for the Assembly) and I am always hearing criticisms. The real sad thing is that practitioners have told me that they are frightened to speak out in case their treatment agency loses money. There is a climate of fear and Wired In is not the only organisation to have heard this.

So, Dr. Gibbons, could we please have a system that understands what it is needed to help people recover from addiction, and starts to implement what is required. Can we have less spin - remember what happened to the father of New Labour spin, Mr Blair - and less of a climate of fear? An analogy - any government can build a hospital. What is required is the building of a hospital with professionals who know what to do to help people get better and are supported in doing it by the government.

If we don't see some real action instead of spin, the people of Wales will start speaking out, despite the underlying threats. And remember, the people pay your wages and those of your staff.

Start doing something that really matters - please!

The need to keep learning

2008-05-23T19:05:00.002+01:00

A conversation today reminded me of something that happened a number of years ago at a conference. I was talking about how we at WIRED wanted to provide an information resource for the field to help practitioners and commissioners.

An agency boss stood up and said this would be of no value because her staff had no time to look at the internet and read because they were too busy with their clients.

I must have been feeling wimpish that day, or just in a polite mood, because I gave some bland comment about the need to keep informed. What I should have said was, "I would get rid of them because they were not doing their job properly. No one is above learning and improving their professional development and practice. No, sorry, I'd get rid of you for allowing this to happen."

Does your boss encourage you to read and keep learning. Or does he/she discourage it?

Drug and Alcohol Findings - bookmark the site and read, read, read!

2008-05-22T19:46:00.004+01:00

I love learning about things and I love trying to solve problems, particularly difficult ones. To me, its a great joy to read what other people have tried to do to tackle and overcome a problem. Even failures teach the reader something - they show you ways that might not be productive.

There are so many things to learn in this fascinating field of substance use, so I read, read, read. And think. There are so many good books and articles that have been written about substance use and misuse - of course, amongst a mass of dross. It is the same in any field.

Every now and again, I come across a new information resource which captures my attention - big-time! This happened when I discovered the Drug and Alcohol Findings magazine edited by Mike Ashton. I was overwhelmed by the information it contained and the high quality of writing. And the different types of section.

I treasured each copy, went mad when someone borrowed one and didn't bring it back, and eventually stored them all in a box file I didn't show people.

Now, thanks to the J. Paul Getty Jr. Charitable Trust and The Pilgrim Trust, and Mike Ashton's unbelievable drive and dedication, it is online (well, not all of it yet). I can get it anytime I want - as long as I have access to the internet. It is wonderful! Life is a beach!!

Now why not go and check what I am raving about. This is such a wonderful information resource. A huge thank you to Mike Ashton.

PS. As an aside, I've discovered I'm one of three information junkies in this field, the other two I know being Mike Ashton and Tim Leighton of Action on Addiction. I'm sure there are more of 'us info junkies' out there. Let me know if you are one as well.

What can we learn from America?

2008-05-21T14:20:00.003+01:00

Interesting to see Kathy Gyngell calling for us to look at the American system in helping people overcome substance use problems, following a visit to the States. Her Blog is well worth a read.

Kathy described the point made by one professional: “the recovery movement here is huge; we do not seem to make as big a deal about ‘abstinence’ versus ‘harm reduction’ as it seems the Europeans do.” She also described a programme that, ‘has significant freedom to decide its own methods and programmes. A far cry from the UK’s state directed hegemony.’

As I have pointed out in my DDN Briefings, the Americans are years ahead of us. We need to be following the example of their Recovery Movement. So few people in this country understand the concept of recovery, know the Faces & Voices of Recovery movement and website, or have heard of William L White (a new member of our Advisory Board) and his seminal work.

This needs to change – urgently. We need to stop protecting the inadequate system we have and start looking outward and forward. Keeping the good things that we have and accepting the achievements we have made.

I have just finished reading an excellent article in the journal Counselor by Bill White on the Recovery Revolution in Philadelphia. Listen to this:

‘The behavioral health system transformation in Philadelphia started by involving everyone in the process — particularly recovering people and their families. A lot of time was spent asking questions and listening to people’s ideas about how the existing behavioral healthcare system could be changed to better meet their needs. What emerged after months of such discussions was a clear vision: create an integrated behavioral health care system for the citizens of Philadelphia that promotes long-term recovery, resiliency, self-determination, and a meaningful life in the community. A Recovery Advisory Committee clarified that vision by developing a consensus definition of recovery and by defining nine core recovery values: hope; choice; empowerment; peer culture, support, and leadership; partnership; community inclusion/opportunities; spirituality; family inclusion and leadership; and a holistic/wellness approach. Seen as a whole, these values shifted the focus of attention from the interventions of professional experts to the experience and needs of recovering individuals and families. The recovery definition and recovery core values were then used to guide the system transformation process in both mental health and addiction service settings.’

We must ask ourselves: is our system in the UK providing those core recovery values? (Hope, yes hope!) What do you think?

Jonathan Kerr-Smith film 'Last Man Out' in New York Film Festival

2008-05-20T19:08:00.005+01:00

We are absolutely thrilled that Jonathan Kerr-Smith, who makes the Wired In films, will make his debut at the New York Film Festival. Jon's feature-length film 'Last Man Out' on William Rodriguez, the last man to leave the World Trade Centre on 9/11, has been selected to be shown at the festival in both New York and Los Angeles.

Jon lives in Penarth, near Cardiff, and has been a life-long friend of Lucie James from Wired In. We hired him to make the 'Personal Stories' of Mark Saunders, and Kevin and Kerry Manley, as well as for several other film projects. He and Lucie have made a formidable team, and we have always appreciated Jon's considerable talents. We now want to raise funding to hire Jon for some more substantial projects we have in mind.

We are so excited for Jon and wish we could be there!!

Why not check out some of Jon's work on our Wired In Recovery channel.

You want treatment?

2008-05-19T19:13:00.012+01:00

I had an interesting Blog Comment from Pavel Nepustil, a Czech republic NGO worker and PhD student, currently in Houston, USA, on a Fullbright Scholarship. Pavel came over to see us in Cardiff last year and we decided we would work together. He is one bright ‘cookie’ and very dedicated to this field. He got a big thumbs-up from the team.

Pavel responded to the Wired In ‘Way Forward’ in a very positive manner. Thanks, Pavel!

Here, I quote parts of his comment, for which I would welcome responses:

‘Hope, passion, talent, change - these are the words that were missing in the drug field! The "deficit discourse" brought by medicine made us think about drug users in terms of illness, disorder, chronic, irreversible disease... and these words created our expectations and these expectations created self-fulfilling prophecy…’

‘When I was asking one former methamphetamine user who recovered without formal treatment about his ideas for the services, he told me: "...it should be designed in such a way so that people will not be afraid to go there. They should offer help, not treatment. A lot of people are afraid of treatment..."’

I have to confess I have been worried about this term ‘treatment’ because what exactly does it mean? Clearly, it means different things to different people. It means something different in the Wired In vision to what it is in today’s system.

What does it mean to a potential client and to their family? Are they afraid to go there as suggested by Pavel’s associate? We certainly know many people who have substance use problems who are very cynical and untrusting of the treatment system and what it represents.

There are many people who are very concerned to hear a senior member of the treatment commissioning system say that the government provides money for people not because of their personal problems but, ‘Because you are seen as a threat, the government is prepared to spend money on drug treatment.’ (quote from DDN, Feb 25^th issue). Would you trust such a system to help you with your own problems, or those of your child?

You might also like to think of something else. The term ‘treatment implies the existence of an entity (such as a drug) or a procedure (such as surgery) that is being applied to something else from without.' (cf. ‘How Clients Make Therapy Work: The Process of Active Self-Healing’ by Arthur C. Bohart and Karen Tallman, pp13).

However, recovery comes from within the person. Addiction is not fixed like a broken leg. The work required to achieve recovery is ultimately done by the person, not by a treatment agency worker or doctor.

The practitioner may facilitate a process that enables the person to achieve more recovery capital (some money, a roof over their head, etc) so they are better able to concentrate on the substance use problem. They may provide methadone to help take chaos out of a person’s life, or their ‘talk’ may help the person alleviate some crisis in their life, or better understand where they are and where they need to go.

Ultimately, good practitioners are providing or enabling support, coaching, guidance, information and resources – or some combination of these.

Is this treatment? Or help? Or what? How we should term it? Any thoughts?

Mark Saunders Personal Story - The Film

2008-05-18T19:33:00.010+01:00

The Independent newspaper commented upon a new film on heroin addiction being shown at the Cannes Film Festival with emotional statements like 'seamy underbelly of rural England', 'unflinching portrayal of addiction' and 'features a teenager's heroin death as a central plotline' - all in the Arts & Entertainment section.

Well, as Jim pointed out in Saturday's Daily Dose, we also use 'real-life heroin addicts' (Independent expression) in our cast - actually ours are ex-addicts. However, we use less emotional language than the Independent, like '...gives hope to others that recovery can be achieved, while also showing the real life side of addiction'.

Wouldn't it be nice to have a recovery film showing at Cannes in the future - Jon, that's your next challenge! [Jon has just had some great news about one of his films]

For now, we introduce you to the filmed Personal Story of Mark Saunders. This was made several years ago - you can tell by the colour of my hair! Mark is still one of our volunteers and you can see his written Personal Story as well. As we pointed out with Kevin and Kerry's film, we have to chop the film into sections to fit on YouTube.

Why not subscribe to the Wired In 'Our Films' Blog, as we will be putting more of our film on YouTube.

The nature of addiction: chronic or not?

2008-05-15T20:17:00.003+01:00

I had an interesting and thoughtful comment about the Wired In 'Way Forward' from Ian Sherwood, with both criticisms and positive remarks. Just the sort of comment needed to provoke further thought and discussion. I'd like to quote one paragraph:

The use of the word "chronic" is unattractive to me and at odds with the idea of recovery, the word has strong connotations of hopelessness and failure. It is technically correct for long term medical conditions such as diabetes which may be cited as comparison cases but no one uses the term "chronically diabetic" because it is a tautology. I feel that the word needs to be replaced in such a statement because it is important to win people over and language is a very important resource."

This really is a difficult one. It's an issue I have been addressing in my recent DDN Background Briefings, the third which I have just this moment sent off to Claire. In my mind, there is no doubt that addiction is a chronic condition, at least for many people. It does not always mean that it is an everlasting condition though. I was seriously addicted to nicotine (and had what I felt were awful withdrawal symptoms - I was a wimp) for over 20 years, but I have had no inclination to smoke for many years now.

If we do not accept that addiction is a chronic condition, then we have more difficulty in justifying the potentially greater resources required to develop chronic, versus, acute models of care.

I agree with Ian we have to be very careful how we communicate the message about the (chronic) nature of addiction. That is in fact the focus of this upcoming Briefing in DDN. Would be great to see some comments on this issue.

New Member of our Advisory Board: William L White

2008-05-14T19:54:00.005+01:00

I am thrilled to introduce a new member of our Advisory Board, William L White, one of the leaders of the Recovery Movement in America. Some of you will know that I introduced Bill's work last year in my DDN Background Briefings on recovery and recovery communities. Exciting stuff!

I have been emailing Bill for a while, and finally asked if he would join up. He said it would be an honour and I have to confess that I was absolutely thrilled. Bill has contributed so much, including writing the two best books I have read in this field - and I have read MANY. You should check out 'Pathways from the Culture of Addiction to the Culture of Recovery' and 'Slaying the Dragon: The History of Addiction Treatment and Recovery in America'.

As far as I am concerned, all treatment agency workers should be provided with these two seminal books to help their professional development and understanding of what they have been employed to do.

There is a lot to learn from Bill and all the people he was worked with, at one level or other. I leave you with Bill White's biography:

William L. White is a Senior Research Consultant at Chestnut Health Systems / Lighthouse Institute and past-chair of the board of Recovery Communities United. Bill has a Master’s degree in Addiction Studies and has worked full-time in the addictions field since 1969 as a street-worker, counselor, clinical director, researcher and well-traveled trainer and consultant.

He has authored or co-authored more than 300 articles, monographs, research reports and book chapters and 13 books. His book, 'Slaying the Dragon - The History of Addiction Treatment and Recovery in America', received the McGovern Family Foundation Award for the best book on addiction recovery. Bill was featured in the Bill Moyers’ PBS special 'Close To Home: Addiction in America' and Showtime’s documentary 'Smoking, Drinking and Drugging in the 20^th Century.'

Bill’s sustained contributions to the field have been acknowledged by awards from the National Association of Addiction Treatment Providers, the National Council on Alcoholism and Drug Dependence, NAADAC: The Association of Addiction Professionals, the American Society of Addiction Medicine, and the Native American Wellbriety Movement.

The Johnson Institute recently published Bill’s widely read papers on recovery advocacy in a book entitled 'Let’s Go Make Some History: Chronicles of the New Addiction Recovery Advocacy Movement'.

Thanks Bill!

The Wired In 'Way Forward'

2008-05-13T22:37:00.003+01:00

I came into this field eight years ago, leaving a successful 25-year career as a neuroscientist, and set up Wired In. I left my day job as a University Professor 18 months ago because I knew I could not do two jobs properly - and only one mattered.

I have been totally infected by the passion that exists in this field. I see people overcome substantial problems, and I am humbled by the incredible courage that they show. And I see the same people being unjustly stigmatised.

I also see so much good quality work going on in this field, so many talented people, so many great ideas. But so much of this is not getting the credit it deserves, and it is not impacting to the extent that it could. One of the major messages this field must give is 'hope'. We don't do it enough, and well enough.

All this must change! As a field, we have what it takes to do so much better and help many more people overcome their problems. Let's do it!

Today, Lucie, Jim, Kevin and my other colleagues at Wired In commit ourselves to trying to help change this situation. Please read our strategy and tell us what you think. We'll be following up on this blog over the coming weeks, discussing various issues.

And sign up to our new Recovery Movement. The people affected by substance use problems need you! Let's make a difference together!!

Film Blog and Subscription to a Reader

2008-05-12T17:57:00.000+01:00

You’ll see we’ve launched a new blog, 'Our films', which we will periodically update with our film material. We will be working in this way until we launch during the summer our new online recovery resource at www.wiredin.org.uk.

Since we have a number of blogs, you may find it difficult to keep up-to-date with all that we are publishing. There’s an easy way to do this - by subscribing to a reader.

When set up, the online feed reader will automatically search our blogs for new material and then put all that material in one place (a webpage) for you to read. This free service takes all the effort out of keeping up with our blogs. And you can access them from anywhere!

How to set it up -

· Click on ‘Subscribe in a reader’ (Right hand column).

· Choose which application to use out of the selection shown (Google is great for beginners!).

· Choose ‘Add to Google Reader’.

· If you have a Google email account then just type in your details. If not, it only takes a couple of minutes to set up a Google account.

· Save your Google Reader account to your Favourites for easy access whenever you want.

Hope you’re enjoying our stuff.

The Personal Story of Kevin Manley: The Film

2008-05-11T23:33:00.000+01:00

Nearly two years ago, I met three special people - Kevin Manley, his mother Kerry, and Jonathan Kerr-Smith.

Today, Wired In releases the film version of Kevin's Personal Story, made by Jonathan Kerr-Smith in association with Lucie James, which focuses on Kevin's 15-year addiction to illicit drugs and subsequent experiences in finding his path to recovery. Kerry talks about the 'hell' that Kevin's family experienced during his problems and her feelings about his recovery.

We have had to break this 35-minute film up into eight parts to fit on to YouTube. After you have looked at Part 1 of the film, please click on ‘More From: wiredinrecovery’ just to the right above the clips. You’ll then find the other parts of our film.

You can also see a shortened version.

Kevin is enjoying his recovery nearly two years later. He has been a long-term and valued volunteer with Wired In, and I also feel honoured in saying that Kevin and I are very good friends. He has shown a courage beyond what I think I will ever be able to achieve in my life. My young children love him to bits. He has so much to offer this field.

Jon is a talented film-maker, as you will see over time as we put up more of our material on the Wired In channel over the coming weeks. He has worked closely with our Wired In colleague Lucie James in producing these films - Lucie has discovered hidden talents. We also thank Sarah Davies for her interview of Kerry.

As a youngster, I wanted to be a film-maker. I even got accepted on to 3-year film course, but never had the courage to take up the challenge of finding the funding. Now, I play the role of bringing these people together and financing a project. I feel so proud being able to do this, helping promote recovery, and nurturing real talent.

Please check out our personal Stories blog, to see Kevin's and Kerry's Personal Story. Also, check this blog on Wednesday when we release the Wired In 'Way Forward'.

Lack of understanding of addiction by many treatment agency workers

2008-05-09T06:27:00.004+01:00

A number of years ago I evaluated projects supported by the largest treatment fund in Wales. I visited a number of projects and talked with the workers, which left me with some distinct impressions. One was that despite the well-meaning nature of many treatment agency workers, they did not appear to understand addiction.

I received a comment on 'The Wired In Way Forward Blog' yesterday, in which the person states that within the 15 years they have been working in the field, little has changed 'in terms of how the majority of well-meaning, caring colleagues understand addiction. Basically they do not understand addiction.' This is what so many people in the field tell me. Please also see article by Neil McKeganey in Drink and Drugs News.

The person, who is a recovering/recovered addict, also points out that for many workers demoralisation settles in because of the apparent lack of impact of their work, and a subliminal message of hopelessness is passed on to clients. Clients are often stigmatised as 'deviant' and inherently 'criminal'. Again I have heard this so many times from practitioners and clients.

I know this does not happen everywhere, but the really good agencies I have visited say that their clients always point out how prevalent it is in the agencies they have previously been for help.

I hate to say it, but I suspect that the majority of the treatment industry is like what is portrayed here. Please tell me I am wrong.

Now please, I am not knocking the industry for the sake of it. And I know that there is a lot of good work going on, and many well-meaning practitioners. But we owe it to these people and the many thousands of people suffering from substance use problems to radically improve the treatment industry.

Please check out the two comments on my last Blog and watch this space next week.

The Wired In Way Forward

2008-05-07T21:00:00.007+01:00

Next week, my colleagues and I will be releasing a document that outlines our views of what we think is wrong with the current treatment system, describes how we think things might be improved, and outlines what we hope to do at Wired In. You might think this foolhardy, particularly, when we currently have no money to implement our plan.

However, we believe that we will bring some clarity to the issue of how society can best help people overcome substance use problems, whilst appreciating that the state does not possess unlimited resources, and knowing that demand will always outweigh supply.

We also believe we have a strong vision! Society needs to modify the way that it is tackling substance use problems, and we think that what we will be suggesting will make a significant difference, if implemented correctly. We also know that there are senior people in this field who strongly support what we will be saying.

I've always said that it is better to have a strong vision and no money, than lots of money and no vision. Well, at least for awhile. We intend to put our vision into the public domain next week, and follow it with discussion on my Blog of a number of key points to facilitate clarity and discussion. Then we intend to go out there and try and raise the money.

Please feel free to comment, whatever you think. If you believe in what we are doing, then say so. If you want to work with us, let us know. And if you want to fund us, or know someone who will fund us, then please get in touch.

Given that our approach is client-centered and focuses on helping people find their personal path to recovery, I leave you with what I consider to be a very helpful definition of recovery, from William L White:

Recovery is the experience (a process and a sustained status) through which individuals, families and communities impacted by alcohol and other drugs (AOD) problems ulilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD-related problems, actively mange their vulnerability to such problems, and develop a healthy, productive and meaningful life."

Does the type of care system for addiction fit the problem?

2008-05-06T18:16:00.004+01:00

In my latest DDN Background Briefing, I continue looking at the nature of addiction and the care system we have developed to help people overcome substance use problems.

I point out that whilst addiction is a chronic disorder, we have developed an acute care model. This means that the successes the treatment system has in helping people overcome serious substance use problems are likely to be limited. There are two important consequences of this serious limitation.

For the field, it means that there will be an erosion of confidence in addiction treatment as a social institution.

For the individual, this means that they are often blamed for their relapse (i.e. showing a symptom of their disorder), rather than the system accepting there are basic flaws in the design or execution of the treatment protocol.

American addiction experts realised the negative ramifications of this mismatch between disorder and care model in the late 1990s. They argued for a shift from an acute care model to a model of sustained recovery management.

I emphasise in my BB that we need to come to the same realisation in the UK and start thinking about a chronic or continuing model of care.

Cannabis: From Gordon Brown to James Langton

2008-05-05T17:28:00.004+01:00

Well my piece on cannabis yesterday prompted a little discussion over bank holiday. I still stand by what I say, that you are not going to reduce the harm that cannabis causes by changing the law.

When will politicians like Gordon Brown learn that? But I guess this is not about the harm the drug causes. It is political. And sadly there will be a fallout, which will be some young people ending up becoming criminalised unnecessarily. Come on PM, there are far more important drug and alcohol issues to get your head around than Class B or C.

Now I happen to be reading an excellent book on cannabis by James Langton, "No Need for Weed: Understanding and Breaking Cannabis Dependency". This is very well-written and takes such a level-headed approach, no moralising, straight down-the-line. The author points out that these are his views and the views of people he knows who have had problems. He does not force himself on anyone - take note, Gordon!

I like the intro, " [the book] is designed to let you consider your relationship with cannabis openly and honestly." This book is for those who experience problems with cannabis - and there are no doubt many, as there are those who don't - and the book looks very helpful. I will be returning to it and James Langton's website on cannabis dependency shortly.

Hysteria and hypocrisy over cannabis

2008-05-04T09:44:00.003+01:00

Excellent article by Professor Colin Blakemore in the Observer today, 'Hysteria over cannabis is getting in the way of the truth', which is well worth reading. He points out that it is a pity that Gordon Brown has allowed his heart to rule his head in his desire to reclassify cannabis, particularly when he has been such a great supporter of science.

I have to confess that I really cannot see what reclassifying the drug will do, other than criminalise and alienate more of our young people. It won't reduce harms that the drug can cause to some people. In saying this, I am not arguing that cannabis is safe - but nor are alcohol, tobacco and a wide range of prescription drugs which are all legal.

So what is Gordon Brown trying to do? Look strong, as stated in one of the article's comments? Or is he trying to protect the health of our young people?

If so, then why isn't he trying to reduce the harm caused by alcohol - many would say government policy has increased harm - and certain addictive prescription drugs. And why isn't he tackling major supermarkets and suppliers who many people argue are using unethical practices in relation to our food, which is creating a massive problem for the country - obesity.

Providing opportunity, choice and hope

2008-05-02T13:52:00.004+01:00

In November last year, I spoke at the Annual Conference of the Federation of Drug and Alcohol Professionals (FDAP). I was one of five speakers asked to participate in a symposium on the first 10-year UK drugs strategy and the future of treatment. My remit was to talk about the importance of empowerment and self-help.

I took this opportunity to put over the Wired In vision of what treatment and recovery support services should look like in the future. Please take a look at my presentation and let me know what you think.

At the start of the talk, I emphasised that whilst the system has made some significant achievements over the past 10 years, this was not surprising as a lot of money had been invested. I pointed out that if we were not careful, we faced the possibility of an American-like situation, where there was a massive disinvestment in treatment in the late 1980s-early 1990s after years of over-promising and under-delivering.

I outlined a number of problems in the current treatment system and emphasised that we needed to change focus towards the person and towards recovery.

I talked about recovery, recovery communities, behavioural change, principles that underlie successful therapeutic interventions, and treatment. I also emphasised how important it is to focus on 'the drug, person and social context' (drug, set and setting), rather than just 'the drug'.

A number of different key concepts were brought together into a model of how we should be viewing the process of helping people overcome substance use problems. In the time available, I could only discuss a limited amount.

Here, I give you the opportunity to read and think about what I had to say. Over the coming few weeks, I will blog on a variety of the topics and issues contained in and around this talk.

I believe strongly that we need to make significant changes in the current treatment system. I also believe that there needs to be a significant enhancement in understanding amongst the treatment workforce of what it takes to help people overcome serious substance use problems (i.e. recover from addiction).

Background Briefings

2008-05-01T20:13:00.003+01:00

My apologies for no posting yesterday but a lot of things needed sorting last few days. I'll be back in full flow next week, with what I hope you will find to be some interesting Blogs.

I would like to point out to you that we have now put links to all 63 of my Background Briefings which have appeared in Drink and Drugs News on another of our Blogs. Please remember they are in reverse order, with the most recent as the top Blog entry.

It's amazing to think that I have written so many. I was so chuffed one day when Professor Neil McKeganey pointed out to me that when they started he thought there would not be that many. I would run out of things to write about. It surprised him that they kept coming... and coming.

Neil, there are a good few more to come, as long as I don't get mowed down by a bus. There is so much to write about in this field. But I really appreciate your positive comments.

It would be really good if people responded to what I write on the BB Blog. It's always good to see what people are thinking. And please keep sending those letters in to DDN!

I have to confess that I really do find it moving when people come up to me at conferences or launches (hi you guys on the Action on Addiction/Bath University degree course) and say how much they appreciate the BBs. Thank you.

I wonder how they know it is me, forgetting that my ugly mugshot is always there. Hopefully, there is a new one this issue. Don't forget to look, because I have written what I feel are some important insights into our treatment system.

About our organisation, Wired In

2008-04-29T16:50:00.006+01:00

Well, I have finally put various pieces of material together to tell you about Wired In, the new identity of what was once WIRED.

For those of you who don't know, I started WIRED about eight years ago as a way of empowering people to tackle substance use problems. I continued doing two jobs for six years, working as a Professor in Psychology at the University of Wales, Swansea, as my day job, and running WIRED in my spare time.

I finally thought, 'enough is enough, I'm never going to make the latter work unless I devote myself full-time', so I took early retirement from the day job. The latter had become very frustrating anyway, because I believe that many universities have lost their way getting bums on seats and forgetting to educate our young people as well as they should.

I hope you find this material of interest and help. In the first document, I describe our aims, achievements to date, and our Charter.

In the second document, I tell you our story, and introduce you to our core team and wider team of consultants, as well as our Advisory Board.

Checking Blog visitors

2008-04-28T17:21:00.006+01:00

It's been a busy day so only sat down with my Blog as evening draws in. Lucie and I finished off an article on recovery and the philosophy of Wired In, so we celebrated by me cooking Chinese, including Lucie's favourite, Chillied Chicken & Leak. An advantage of me working at home.

Then we had our first play with Google Analytics, looking at the Blog statistics over the past month. I was really pleased to see that there have been 2,250 'absolute unique visitors' to the Blog since it started a month ago. Yes, over two thousand different people appeared to have visited!

Of course, these visitors have not materialised out of nowhere. The vast majority of you were referred from Daily Dose, which just goes to show you that our news portal has more than one good function!

Of the Blog visitors, 91.8% returned a second time. And nearly 500 people have visited on eight or more occasions. I am absolutely thrilled since this shows I must be writing something of interest, at least some of the time. I certainly hope I can maintain your interest, and stimulate controversy and debate over the coming months.

Please do feel free to comment, it will really help increase discussion in this field.

I guess that there is no time to rest, I better start writing some new material for the Blog.

A very big thank you to you all.

What can we do, to reduce the incidence of drug overdose?

2008-04-25T08:13:00.007+01:00

I gave a talk at a conference in Swansea in June last year focusing on drug overdose. This excellent conference was organised by Swansea Drugs Project.

I wanted to point out that we can do a lot to reduce the incidence of drug overdoses, using an approach that involves: users and user networks; families and friends; specialist and generalist workers; commissioners and policy makers; the press, and members of the general public. I emphasised that we need an understanding and responsible society, and this can only be achieved by increasing awareness about drug overdose.

The talk focused on:

the incidence of drug overdose
risk factors underlying overdose
complications arising from non-fatal overdose
how to react to a drug overdose
getting the message out to users
helping family members
providing education and training to workers
ensuring that users get adequate health care
what emergency services and witnesses can do
importance of users having access to naloxone
the impact of prejudice, stigmatisation and stereotyping.

Two of our volunteers, Kevin Manley and Mark Saunders, who are recovering heroin addicts, spoke at the conference and received a tremendous reception. They brought home the reality of drug overdose and the reactions of drug users to overdose.

Not only were Kevin and Mark's talks of the highest quality, but many people commented to us that they were in complete contrast to those given by 'authority figures' who did not really appreciate the reality of the situation and the key issues surrounding drug overdose. If you listened to these 'authority figures', you would think that Wales was leading the way in tackling overdose, when we are now only doing things that have been done in Australia, for example, many years ago. And not doing many other critical things.

I hope you find this powerpoint presentation of the talk of interest and help. Please excuse the funny bullet points - the originals were converted to these by the pdf process. Strange!

We must modify our treatment system so that it can effectively help people recover from the chronic disorder addiction

2008-04-23T19:53:00.009+01:00

In my latest Background Briefing for Drink and Drugs News, 'Nature of the problem: Addiction as a chronic disorder', I start to look at the time course of addiction and how it influences the way that we should be building systems, including for the delivery of treatment, that help people find recovery.

In this lastest Briefing, I looked at acute and chronic disorders and how they are managed in today's medical world. I focused on a recent key article written by two of the leading addiction scientists, Bill White and Thomas McLellan.

The issues I discussed are fundamental to the substance misuse treatment system in the UK and to the considerable amount of money the country is investing in this system. A system has been built to manage an acute disorder - but addiction is not an acute disorder.

Quite simply, we must modify our treatment system so that it can effectively help people recover from the chronic disorder of addiction.

Do you agree?

The need for a better trained workforce

2008-04-22T20:49:00.005+01:00

Professor Neil McKeganey argued in Drink and Drugs News that there is an urgent need for a greater training of workers in the treatment field. He pointed out that workers need to 'understand the nature of drug dependency and the opportunities for recovery' and a variety of other complex issues to do their job well. At the end of the day, peoples' lives can be at stake.

Professor McKeganey was criticised in the letters section of the next issue of DDN. In one case, his article was described as 'extremely patronising and insulting to many of those in the field...' He and Tim Leighton, Director of the newly-formed Centre for Addiction Treatment Studies, provided sound responses to these letters in the last issue of DDN.

From my experiences, there is an urgent and substantial need for greater training in the treatment field. It would be totally wrong for this field to feel that it is above this need. I have met treatment workers who have a poor understanding of key issues - in some cases I and others have been horrified by their knowledge and understanding - and I have met others who know a great deal. The latter, however, are often the first to admit that they need and want to learn more. We also know that funding for training is almost the first thing that is cut. I cannot see how anyone can defend the current situation, except in some cases.

In arguing this, I am not saying that there aren't excellent and knowledgeable people in the field who haven't been well-trained. I'm not knocking the value of experience. I'm not saying that a University training is essential, although it certainly can be very good. As External Examiner for the Action on Addiction/Bath University degree in Addictions Counselling, I can vouch for the outstanding quality of this course and the considerable value it is to the field. At the same time, I have seen rubbish degrees in Universities and would seriously question their value - the old arrogant ivory tower syndrome would certainly come into play in some places.

What I am saying is that we need to greatly improve the level of knowledge and understanding in the treatment field, in particular in relation to how we help people move from the culture of addiction to the culture of recovery. This knowledge can be provided on the basis of what we know from leading scientific research, best practice, and the views and experiences of people affected by substance use problems and by practitioners. We also need a significant financial investment in training.

We at Wired In are committed to helping improve professional standards in the treatment field, in part by providing new education and training materials.